^r.J"T^H'tcVH«."c*J'l?^°l?' 


HX64070573 
RK52lAn41897    The  Angle  system  ot 


RECAP 


• 


THE  ANGLE  SYSTEM 


OF 


REGULATION  AND  RETENTION 
OF  THE  TEETH, 


AND 


TREATMENT  OF  FRACTURES  OF  THE  MAXILLA. 


Fifth  Edition  Revised. 


With  One  Hundred  and  Fifteen  Illustrations. 


BY 

EDWARD  H.  ANGLE,  D.D.-S:, 

Member  of  the  American  Dental  Association,  and  Honorary  Member  of  the  American 
Dental  Society  of  Europe;  Former  Professor  of  Histology,  OrtAodontia,  and  Com- 
parative Anatomy  of  the  Teeth,  in  the  Dental  Department  of'the  Univkrsity 
OF  Minnksota;  Professor  of  Orthodontia  and  Lecturer  on  Fractures  of  tmk 
Maxill/E  in  the  Northwestern  University  Dental  School,  cSncAGo,  III.; 
Professor  of  Orthodontia  in  the  Dental  Department  of  the  Marion- 
Sims  College  of  Medicine,  St.  Louis,  Mo.;  Surgeon  to  the  Asbury  Hos- 
pital in  Minneapolis,  Minn.,  and  Surgeon  for  the  Treatment  of 
Fractures  of  the  Maxill/E  to  the  Great  Northern  Railway. 


PHILADELPHIA  : 

THE  S.  S.  WHITE  DENTAL  MFG.  CO. 
1899. 


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im 


CoUege  of  ^tjpjficiang  anb  ^urgeonjf 


Digitized  by  tine  Internet  Arciiive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/anglesystemofreg1897angl 


THE  ANGLE  SYSTEM 


OF 


REGULATION  AND  RETENTION 
OF  THE  TEETH, 


AXD 


Treatment  of  Fractures  of  the  Maxilla. 


Fifth  Edition,  Revised. 


With  One  Hundred  and  Fifteen  Illustrations. 


EDWARD  H.  ANGLE,  D.D.S., 

Member  of  the  American  Dental  Association,  and  Honorary  Member  of  the  American 
Dental  Society  of  Europe;  Former  Professor  of  Histology,  Orthodontia,  and  Com- 
parative Anatomy  of  the  Teeth,  in  the  Dental  Department  of  the  University 
of  Minnesota;  Professor  of  Orthodontia  and  Lecturer  on  Fractures  of  the 
Maxill/E  in  the  Northwestern  University  Dental  School,  Chicago,  III.  ; 
Professor  of  Orthodontia  in  the  Dental  Department  of  the  Marion- 
Si.Ms  College  of  Medicine,  St.  Louis,  Mo.;  Surgeon  to  the  Asburv  Hos- 
pital in  Minneapolis,  Minn.,  and  Surgeo.v  for  the  Treatment  of 
Fractures  of  the  Maxillae  to  the  Great  Northern  Railway. 


PHILADELPHIA  : 

THE  .S.  S.  WHITE  DENTAL  MFG.  CO. 
1S99. 


Copyright  1894,  by  Edward  H.  Angle,  D.D.S.,  Minneapolis,  Minn. 
Copyright  1897,  by  Edward  H.  Angle. 


PREFACE  TO  THE  FIFTH  EDITION. 


At  the  earnest  solicitation  of  numerous  students  and  teachers  it 
had  been  the  author's  intention  in  preparing  the  fifth  edition  to 
rewrite  and  rearrange  the  subject-matter  more  in  keeping 
with  the  exacting  requirements  of  a  complete,  modern  text-book 
on  Orthodontia.  But,  owing  to  the  fact  that  the  fourth  edition 
has  had  such  a  wide  circulation,  having  been  published  in  part  in 
periodicals,  compendiums,  and  text-books  both  dental  and  surgi- 
cal, and  complete  translations  in  the  French,  German,  Dutch, 
Scandinavian,  and  Spanish  languages,  it  has  been  thought  advis- 
able, in  order  to  prevent  the  confusion  which  would  result  from 
the  rearranging  of  pages  and  numbering  of  cuts,  to  incorporate 
the  new  subject-matter  in  the  form  of  a  Supplement*  into  the  cor- 
rected and  but  slightly  modified  fifth  edition. 

As  the  fruits  of  a  busy  practice, — the  author  has  devoted  his 
time  exclusively  to  the  practice  and  teaching  of  Orthodontia, — the 
Supplement  will  be  found  to  contain  numerous  additions  and  mod- 
ifications of  combinations,  also  new  combinations,  together  with 
suggestions  and  comparisons,  and  a  more  comprehensive  plan  of 
nomenclature  and  classification  of  irregularities  from  the  basis  of 
occlusion;  all  of  which  the  author  believes  will  still  further  simplify, 
for  both  student  and  teacher,  the  study  and  practice  of  this  most 
useful  branch  of  dental  science. 

Edward  H.  Angle. 

St.  Louis,  Mo.,  August,  1897. 

♦This  Supplement  is  now  in  course  of  preparation,  but  is  delayed  because 

of  the  necessity  of  making  a  large  number  of  illustrations.     When  published 

it  will  be  available  to  those  who  have  the  fourth  edition,  equally  with  the 

purchasers  of  this  volume. — Publisher. 

iii 


TABLE  OF  CONTENTS. 


PART  I. 
ORTHODONTIA. 

CHAPTER  I.  p^^^ 

General  Consideration  of  Orthodontia 7 

Set  No.  1  Angle's  Appliances,  Description  of 9 

Set  No.  2  Angle's  Appliances,  Description  of 10 

Extras,   Description  of 10 

CHAPTER  n. 

Teeth  Bands,  Adjustment  of 13 

Ligatures 17 

CHAPTER  HI. 
Tools  Used  in  Operating  Appliances 20 

CHAPTER  IV. 
Soldering  20 

CHAPTER  V. 
Impression  and  Model  Making 23 

CHAPTER  VI. 
Direction  of  Forces  for  Tooth-Movement. 

Backward  in  Line  of  the  Arch 28 

Forward  in  Line  of  the  Arch 31 

Outward  in  Line  of  the  Arch 31 

Inward  in  Line  of  the  Arch 36 

Rotation    37 

Double  Rotatioti   ■ 40 

Elevation    41 

Expansion    44 

CHAPTER  Vn. 

Practical  Cases. 

Illustrations  and  Treatment  of  Miscellaneous  Cases 48 

Jumping  the   Bite 63 

Excessive  Protrusion  of  the  Upper  Teeth 67 

Excessive  Protrusion  of  the  Lower  Teeth 74 

CHAPTER  VIII. 
General  Suggestions 80 

5 


D  TABLE  OF  CONTENTS. 

PART  11. 

FRACTURES  OF  THE  MAXILLA. 

CHAPTER  I. 
Treatment  of  Fractures  of  the  Maxillse 


CHAPTER  II. 
Final  Suggestions  on  Fractures 


PART  I. 

ORTHODONTIA. 


CHAPTER    I. 

THE  ANGLE  SYSTEM  OF  TEETH-REGULATION  AND  RETENTION. 

It  is  often  asserted,  even  by  some  authoritative  writers  upon  the 
treatment  of  dental  irregularities  (Orthodontia),  that  no  fixed 
system  of  appliances  should  or  can  be  depended  upon;  that  each 
case  so  differs  from  all  others  as  to  require  some  neu^  appliance 
peculiarly  suited  to  that  case,  and  that  only. 

Upon  this  theory,  success  would  demand  not  only  skill  in  opera- 
tion, but  the  constant  exercise  of  inventive  genius.  The  inventive 
faculty  is  rather  a  natural  gift  than  an  acquirement,  and  can  be 
exercised  successfully  only  by  the  favored  few,  while  even  the 
greatest  inventor  must  be  an  experimenter.  Hence  all  treatment 
upon  such  theory  must  be,  and  in  fact  has  ever  been,  tedious, 
costly,  and  of  doubtful  result. 

It  is  probable  that,  for  the  foregoing  reasons.  Orthodontia  has 
never  received  that  attention,  even  in  the  schools  of  dentistry,  that 
its  importance  demands. 

The  author  believes,  and  has  proven,  that  it  is  not  only  possible, 
but  practicable,  to  systematize,  classify,  and  provide  ready-made 
regulating  appliances,  reducing  them  to  a  few  simple  forms,  to 
meet  by  their  combinations  the  requirements  in  all  varieties  of 
cases  susceptible  of  treatment. 

The  present  purpose  is  to  submit  such  a  system,  explain  the 
character  and  use  of  the  appliances,  and  show  by  cuts  of  models  of 
actual  cases  the  methods  of  treatment.  The  appliances  shown  in 
Sets  No.  I  and  No.  2,  and  the  few  extra  pieces  following  them, 
have,  in  fact,  fully  and  readily  met  the  requirements  of  every  case, 
while  combinations  of  them,  other  than  those  hereinafter  shown, 
have  rarely  been  necessary. 


8  THE   ANGLE    SYSTEM. 

The  author  will  always  be  glad  to  afford  the  profession  ample 
opportunity  to  inspect  his  collection  of  models  of  actual  cases 
treated,  which  correctly  show  each  stage  of  the  operation  from 
beginning  to  completion;  and  he  feels  sure  that,  for  variety  of 
difficulties  to  be  overcome,  facility  and  certainty  of  operation,  and 
success  in  results,  all  clearly  shown  by  the  models,  this  collection 
will  compare  favorably  with  any  other  in  the  world. 

The  claim  made  by  many  authors,  teachers,  and  practitioners, 
that  each  dentist  should  from  raw  materials  make  his  own  ap- 
pliances for  use  in  Orthodontia,  is  quite  as  unreasonable  and  im- 
practical as  to  require  him  to  make  all  his  own  instruments  for 
use  in  other  branches  of  dentistry;  and  the  time  spent  by  the 
student  in  the  dental  schools  to  acquire  constructive  knowledge 
and  skill  for  either  purpose  could  and  should  be  more  profitably 
spent  in  the  study  of  actual  cases,  and  of  the  application  of  estab- 
lished forms  of  appliances  and  instruments  made  by  skilled  experts, 
who  have  become  so  not  only  from  natural  ability,  but  by  intense 
study  and  long  practice. 

The  author  claims  that  his  system  can  be  easily  taught  and 
learned  in  the  dental  schools;  that  the  dentist  may  quickly  acquire 
a  complete  knowledge  of  it;  and  that  the  practice  of  Orthodontia, 
instead  of  being  regarded,  as  heretofore,  as  tedious  and  unsatisfac- 
tory, something  to  be  avoided  rather  than  sought  for,  may  be  made 
one  of  the  most  useful,  satisfactory,  and  lucrative  branches  of 
dentistry. 

Dr.  Farrar  seems  also  to  have  become  convinced  of  the  practica- 
bility of  what  has  been  heretofore  stated,  for  he  says  in  vol.  xx, 
page  20,  of  the  Dental  Cosmos, — 

"It  has  for  some  time  been  evident  to  me  (though  by  most  peo- 
ple thought  to  be  impracticable)  that  the  time  will  come  when  the 
regulating  process  and  the  necessary  apparatus  will  be  so  systema- 
tized and  simplified  that  the  latter  will  actually  be  kept  in  stock,  in 
parts  and  wholes,  at  dental  depots,  in  readiness  for  the  profession  at 
large,  so  that  it  may  be  ordered  by  catalogued  numbers  to  suit  the 
needs  of  any  case;  so  that  by  a  few  moments'  work  at  the  blow- 
pipe in  the  laboratory  the  dentist  may  be  able,  by  uniting  the  parts, 
to  produce  any  apparatus,  of  any  size  desired,  at  minimum  cost  of 
time  and  money." 

Section  I.  The  limits  of  this  book  will  not  permit  of  an  ex- 
haustive treatise  on  the  subject  of  Orthodontia  generally,  and  the 
author  will  therefore  confine  himself  to  the  description  and  use  of 
the  appliances  and  methods  of  treatment  which  he  has  found  so 


TEETH-REGULATION    AND    RETENTION.  9 

satisfactory  in  an  extensive  practice,  believing  that  most  practi- 
tioners will  succeed  best  by  adopting  one  complete  system  and 
thoroughly  familiarizing  themselves  with  the  same. 

To  those  who  may  desire  to  study  the  subject  in  all  its  relations, 
together  with  the  history  of  methods  and  appliances  in  general, 
he  would  recommend  the  excellent  treatises  of  Drs.  Guilford  and 
Kingslev. 


Fig.  I. 


bl-i     No.    I.      .V.NuLli'b   .Vrl'LlANCKS. 


It  IS  essential  to  a  clear  comprehension  of  the  manifold  uses  of 
the  several  appliances  to  which  frequent  references  will  subse- 
quently be  made  that  their  names,  shapes,  sizes,  and  indicating 
numbers  or  letters  should  be  carefully  noted  and  kept  in  mind. 
Every  part  is  important;  none  can  well  be  omitted. 

For  convenience  of  description  and  designation,  they  are  divided 
into  Sets  No.  i  and  No.  2,  together  with  a  few  extra  parts.  Any 
piece,  however,  may  be  ordered  separately,  as  all  of  a  kind  are 
interchangeable,  and  each  accurately  fits  the  part  to  which  it  be- 
longs. 

The  Set  No.  i,  Fig.  i,  consists  of  the  retaining-wire  G,  and  ten 
sections  of  retaining  and  anchor  pipes  R,  R,  which  will  closely 
slide  on  wire  G.  The  traction-screw  A  has  its  smooth  end  bent 
for  insertion  in  the  short  tube  D-  When  the  nut  is  against  the  A 
end  of  the  long  tube,  and  that  tube  soldered  to  a  tooth-band,  turn- 
ing forward  the  nut  will  pull  the  hook  in  the  tube  D  when  that  has 
been  soldered  to  a  tooth-band;  if  the  nut  is  against  the  other  end 


lO  THE    ANGLE    SYSTEM. 

of  the  long  tube,  it  will  pitsh  D  and  its  tooth-band.  B,  C,  is  a  like,. 
but  smaller  combination,  of  the  same  diametric  size  as  the  jack- 
screw  J.  When  the  tube  of  J  is  soldered  to  a  tooth-band  on  one 
tooth,  it  will  push  directly  against  a  notched  tooth-band  or  a  tooth. 
E  is  a  longer  piece  of  the  tube  than  is  shown  on  J,  with  which  a 
longer  jack-screw  may  be  made  when  required.  The  thinner,  coil 
of  band-material  is  seen  at  F,  the  thicker  at  H,  either  of  which  is 
sufficient  to  make  about  twenty-five  tooth-bands.  The  rotating 
levers  L,  three  sizes  of  two  each,  and  wrench  W,  complete  the  set, 
which  will  suffice  for  several  regulating  cases. 

It  will  thus  be  seen  that  the  appliances  of  this  set  are  very  simple 
and  few  in  number,  being  limited  practically  to  three, — viz,  the 
lever  for  rotating,  the  screw  for  pushing,  and  the  traction-screw 
for  pulling;  and  the  other  pieces  for  the  purpose  of  securing  attach- 
ments. Aside  from  their  advantages  of  simplicity,  efficiency,  and 
cleanliness,  their  intelligent  application  will  effect  a  stationary 
anchorage  upon,  a  positive  movement  of,  and  afterward  a  firm 
retention  of,  the  teeth. 

Section  II.  Set  No.  2  is  designed  for  the  treatment  of  a  special 
class  of  irregularities,  or  that  prognathic  type  known  as  excessive 
protrusion  of  the  upper  incisors.  The  plan  of  this  set  (No.  2) 
differs  principally  from  that  of  Set  No.  i  in  that  the  anchorage  is 
occipital,  or  by  means  of  a  cap  covering  the  back  of  the  head  (as 
seen  in  Fig.  3),  to  which  heavy  elastic  bands  are  attached  and 
received  by  the  hooks  upon  the  ends  of  traction-bar  A. 

The  wire  arch  B  encircles  the  dental  arch  and  bears  against  the 
protruding  teeth,  receiving  the  necessary  pressure  from  the 
standard  in  the  center  of  the  traction-bar.  D,  D  represent  adjust- 
able anchor  clamp-bands  and  pipes  for  securing  the  ends  of  the 
arch  B  upon  the  molar  teeth,  while  C,  C  represent  plain  bands  for 
holding  in  position  upon  the  teeth  the  anterior  part  of  the  arch,  as 
shown  in  Fig.  84.  C  is  a  coil  of  band-material,  from  which  the 
bands  C,  C  are  to  be  made  for  each  case.  This  coil  is  the  same  as 
F,  Fig.  I,  Set  No.  i. 

E,  E  represent  small  rubber  rings  to  retain  the  teeth  during  in- 
tervals of  rest,  when  not  wearing  the  head-cap  and  traction-bar,, 
also  shown  in  Fig.  84. 

Extra  Parts. 

Section  III,  Fig.  4  shows  an  extra  wire  expansion-arch.  Its 
use  is  directly  the  opposite  of  that  of  wire  arch  B,  in  that  it  is  used 
for  expanding  the  arch,  and  is  to  be  known  as  the  expansion-arch 


teeth-regulation  and  retention, 
Fig.  2. 


II 


Set  No.  2.    Angle's  Appliances. 


Fig.  3. 


E.  The  ends  of  this  arch  are  threaded  and  provided  with  nuts.  By- 
putting  the  threaded  ends  into  the  anchor-tubes  upon  the  clamp- 
bands  D,  Set  No.  2,  secured  to  anchor-teeth,  the  arch  may  be 
pushed  forward  by  tightening  the  nuts,  thus  exerting  force  against 
other  teeth  which  may  have  been  secured  to  the  arch  by  means  of 
ligatures  or  bands. 

[This  arch  is  not  inckided  in  Set  No.  2,  but  must  be  ordered 
separately,  as  also  the  extra  bands  and  tubes  D,  Fig.  2,  with  which 
it  is  always  used.) 


12 


THE   ANGLE    SYSTEM. 


In  Fig.  5  is  shown  a  metal  cap  covering  the  chin,  and  in  connec- 
tion with  the  head-gear  and  heavy  elastic  bands  it  is  used  in  the 
retraction  of  the  inferior  maxilla,  as  shown  in  the  figure.  This  cap 
is  light,  nicely  made,  highly  polished,  and  will  fit  all  cases,  as  it  is 
necessary  for  fit  to  be  only  approximately  accurate.     A  layer  of 

Fig.  4. 


absorbent  cotton  should  always  be  placed  between  the  metal  and 
the  chin  while  it  is  being  worn. 

Fig.   6  represents   adjustable   clamp-bands   for   encircling  the 

Fig.  ^. 


molars  and  bicuspids,  to  which  are  attached  the  various  appliances. 
Nos.  3  and  4  have  pins  soldered  to  their  sides,  to  which  ligatures 
may  be  attached.  This  style  of  band  is  especially  designed  for  the 
treatment  of  fractures  of  the  maxillse,  and  its  use,  therefore,  is  fully 


TEETH    BANDS.  I3 

shown  in  that  portion  of  this  work  devoted  to  such  treatment,  but 
it  is  also  useful  in  the  regulation  of  teeth,  as  described  later. 

The  head-cap  represented  as  covering  the  back  of  the  head  (Fig. 
5)  is  also  an  extra.     It  is  beautifully  made  and  presents  a  very  neat 

Fig.  6. 


Xo.  2 — Molar.  Xo.  3 — Biccspid.  Xo.  4 — Molar. 


appearance,  is  strong,  durable,  and  may  be  quickly  adjusted  to  fit 
any  size  of  head.  As  auxiliaries  to  the  above  appliances,  ligatures 
made  from  waxed  floss  silk,  or  wire,  are  necessary. 


CHAPTER    II. 

B.\XDS    AND    LIGATURES. 

Section  I.     Teeth  Bands. 

In  this  system  two  kinds  of  bands  are  used  for  attaching  the 
appliances  to  the  teeth:  the  plain  or  soldered  band  (C,  C,  Fig.  2), 
and  the  clamp  or  adjustable  band  (Fig.  6).  The  plain  band  is 
made  from  the  coil  of  band-material,  F  and  H,  Fig.  i.  F  is  thinner 
and  narrower  than  H,  and  is  generally  used  on  the  lower  incisors 
or  upper  laterals,  or  where  a  delicate  band  is  desirable.  It  is  ex- 
tremely thin,  being  .003  of  an  inch  in  thickness,  so  that  it  will 
readily  pass  between  the  teeth  and  occupy  but  little  space;  yet  the 
material  is  so  strong  that  it  will  resist  all  necessary  strain  if  not 
overheated.  H  is  .004  of  an  inch  in  thickness,  and  is  used  in 
making  the  bands  for  the  central  incisors  or  cuspids.  Each  coil  is 
sufficient  for  about  twenty-five  bands. 

I  have  long  discontinued  the  use  of  plain  bands  upon  the  molars 
and  bicuspids,  for  it  is  impracticable  to  fix  and  cement  them  on 
the.se  teeth  Cowing  to  their  unfavoral)lc  shapes  and  positions),  so 
that  they  will  not  .soon  loo.scn  under  the  severe  strain  to  which  they 
are  subjected. 

The  adjustable  clamp-bands,  Nos.  i  and  2,  are  far  more  con- 
venient and  desirable,  being  easily  and  quickly  clamped  and  bur- 


14  THE   ANGLE    SYSTEM. 

nished  to  fit  the  tooth  so  that  they  will  not  loosen,  and  cement  is 
unnecessary,  except  in  such  combinations  as  shown  in  Fig.  17, 
where  stationary  anchorage  is  necessary.  Another  advantage  is 
in  their  ready  removal  and  replacement,  should  changes  in  their 
attachments  be  necessary. 

These  bands  are  made  in  two  sizes,  which  have  been  determined 
by  the  accurate  measurement  of  a  large  number  of  bicuspids  and 
molars.  They  will  fit  all  teeth  of  normal  size,  and  may  be  enlarged 
to  accommodate  teeth  of  unusual  size  by  beating  the  first  third  or 
half  of  the  screw  flat  over  the  horn  of  an  anvil;  to  reduce  the  size 
for  abnormally  small  teeth  it  is  only  necessary  to  cut  the  band 
midway  of  the  flat  portion,  lap  the  desired  distance,  and  resolder. 

In  adjusting  them  to  the  teeth  extreme  care  should  be  exercised 
not  to  crimp,  tear,  or  injure  them  in  any  way.  If  there  is  not  space 
to  admit  their  passage,  it  should  be  provided.  The  nut  should  be 
loosened  and  the  band  enlarged  to  the  approximate  size,  then  with 
a  pair  of  flat-nosed  pliers  the  band  should  be  carefully  bent  to  take 
the  form  of  the  tooth,  and,  if  properly  shaped,  may  be  easily 
worked  over  the  crown  to  any  desired  point  with  the  fingers  alone, 
sliding  beneath  the  festoon  of  the  gum  and  not  pressing  upon  it. 
The  hand  should  never,  under  any  circumstances,  be  Med  or  cut  away 
to  avoid  contact  with  the  gum.  Never  be  content  to  stop  when  the 
band  is  only  one-half  or  two-thirds  over  the  crown,  as  the  entire 
strain  is  then  borne  by  that  partial  portion  of  the  band,  and  break- 
ing or  slipping  off  is  almost  certain  when  the' nut  is  turned.  Care- 
fully work  the  band  to  exactly  the  position  desired,  then  tighten 
the  nut  and  burnish,  alternately,  until  the  fit  is  accurate.  Burnish- 
ing is  important  not  only  to  enhance  the  fit,  but  to  harden  and 
strengthen  the  material. 

As  the  bands  are  so  important  in  this  system,  and  the  making 
and  fitting  of  the  plain  bands  the  most  difficult  part  in  the  con- 
struction of  any  of  the  combinations,  I  would  recommend  that 
accuracy  and  care  be  observed  in  each  step  in  the  operation.. 
First,  in  order  to  insure  perfect  uniformity  in  annealing,  the  coil  of 
band-material  should  be  heated  and  plunged  in  dilute  sulfuric  acid 
before  cutting  the  wire  ligatures  encircling  it.  A  loop  in  the  band- 
strip  is  then  slipped  over  the  tooth  to  be  banded,  and  worked  up  or 
down  upon  the  crown  to  the  exact  point  it  is  to  occupy  when  com- 
pleted. It  is  held  between  the  thumb  and  finger,  and  tightly 
drawn  around  the  tooth  against  the  opposite  side  from  which  the 
union  is  to  be  made.  While  thus  firmly  held  it  is  grasped  between 
the  flattened  beaks  of  a  pair  of  strong  pliers,  and  pinched  or  drawn 
tightly  about  the  tooth,  a  burnisher  being  applied  at  the  same  time 


TEETH    BANDS.  I5 

to  make  it  conform  still  more  accurately  to  the  shape  of  the  tooth. 
It  is  important  that  the  beaks  of  the  pliers  should  be  smooth  and 
fit  together  accurately.  It  is  then  removed  and  presents  the  ap- 
pearance of  Fig.  7.  A  piece  of  clean  silver  solder,  about  one- 
eighth  of  an  inch  square,  wet  with  borax  cream,  is  now  placed 
between  the  jaws  at  the  junction  and  held  there  by  being  pressed 
together  with  the  delicate  soldering  pliers  E,  Fig.  8  A.  It  is  then 
held  over  a  fine,  sharp  soldering  flame.  When  soldered,  the  inner 
surface  of  the  band  should  present  one  continuous,  even  surface; 
any  other  union  is  imperfect  and  should  not  be  used. 

The  band  is  now  ready  for  any  attachments  which  may  be  made, 
the  untrimmed  ends  of  the  band  serving  the  useful  purpose  of  a 
handle  for  holding  the  band  in  the  flame  and  in  contact  with  the 
piece  to  be  attached,  while  soldering,  as  in  G  and  H,  Fig.  21. 
After  the  attachment  has  been  made  the  ends  of  the  bands  are 
trimmed  of¥,  leaving  them  long  or  short  as  desired. 

Fig.  7. 


If  a  niche  is  to  be  formed  as  in  A,  Fig.  21,  or  C,  C,  Fig.  2,  the 
ends  are  left  about  one-sixteenth  of  an  inch  long;  but  if  not  to 
ser\-e  as  a  means  of  attachment  they  may  be  trimmed  still  shorter, 
though  it  is  never  desirable  to  trim  them  even  with  the  surface  of 
the  band.  These  united  ends  may  be  further  strengthened  by  an 
extra  piece  of  the  band-material  held  between  the  jaws  at  the  junc- 
tion when  soldering. 

It  should  now  be  boiled  in  a  few  drops  of  dilute  sulfuric  acid  in 
a  small  test-tube  or  other  suitable  vessel,  after  which  it  is  washed 
and  dried.  The  tooth  should  now  be  protected  from  moisture  by 
a  small  roll  of  cotton  or  bibulous  paper,  the  surface  of  the  tooth 
cleansed  by  a  pledget  of  cotton  moistened  with  alcohol  or  ether, 
and  dried  with  the  chip-blower.  A  sufficient  quantity  of  oxyphos- 
phate  of  zinc  to  fill  the  band  is  now  mixed  to  a  creamy  consistence, 
then  carried  on  the  end  of  the  finger  to  the  tooth,  forcing  the 
cement,  as  well  as  band,  on  to  the  tooth.  By  carefully  working 
with  the  fingers  alone,  the  band  is  forced  nearly  to  its  desired  posi- 
tion, which  may  be  completed  by  a  few  gentle  taps  from  the  mallet 
and  band-driver  TI.  and  M,  Fig.  9>  B).  The  burnisher  is  now 
quickly  applied  and  the  surplus  cement  wiped  off.  Tf  the  opera- 
tion has  been  carefully  performed  the  band  will  fit  with  the  most 


l6  THE   ANGLE    SYSTEM. 

glove-like  accuracy  at  every  point,  so  that  it  will  occupy  the  least 
possible  space,  which  is  very  desirable  in  most  cases.  The  attach- 
ment will  be  so  firm  that  the  annoyance  of  loosening  will  be 
obviated.  Only  a  perfectly-fitting  band  can  be  firmly  attached. 
If  the  band  is  defective  in  any  particular,  as  too  large,  weakened 
by  crimping,  or  slightly  torn  when  driven  in  position,  it  should  be 
immediately  condemned,  and  a  more  perfect  one  substituted^  for 
sooner  or  later  it  will  surely  fail  and  cause  annoyance. 

It  is  most  important  that  the  operation  of  banding  should  be 
thoroughly  performed,  and  at  the  first  operation,  or  before  the 
tooth  has  become  tender  by  being  moved. 

In  making  the  band,  it  is  desirable  that  all  the  attachments 
which  will  be  needed,  both  in  moving  and  retaining,  shall  be  added 
before  first  setting  the  band,  in  order  that  the  subsequent  pain  and 
trouble  of  loosening  and  resetting  may  be  avoided. 

A  little  experience  (and  I  would  recommend  also  practice  upon 
teeth  out  of  the  mouth)  will  soon  enable  the  operator  to  quickly, 
easily,  and  perfectly  band  any  tooth. 

In  cases  where  the  teeth  are  crowded  firmly  together,  leave  the 
band  in  position  upon  the  tooth  for  a  few  hours,  or  over  night, 
before  finally  cementing.  Sufficient  space  will  thus  be  gained  so 
that  the  band  may  be  readily  cemented  without  crimping. 

A  cuspid  is  the  most  difficult  of  any  of  the  teeth  to  band,  but  by 
forming  a  seam  on  the  lingual  slope  and  firmly  burnishing  the 
outer  surface  while  it  is  being  pinched,  an  accurate  fit  can  in  most 
instances  be  made;  or,  by  making  the  union  on  the  labial  surface, 
and  pinching  a  fold  on  the  lingual  slope  and  again  soldering,  an 
accurate  fit  may  be  obtained. 

After  a  band  has  been  set,  and  the  cement  thoroughly  hardened, 
the  band  should  be  carefully  polished  and  burnished,  as  it  is  well 
known  that  discoloration  is  less  liable  with  a  smooth,  polished 
surface  than  a  rough  one.  I  have  found  nothing  nearly  so  efifec- 
tive  for  removing  the  superfluous  cement  and  polishing  the  sur-. 
face  of  the  band  as  little  leather  poHshing-wheels. 

When  desirable  to  loosen  the  band,  never  attempt  to  do  so  with 
forceps,  as  the  shock  to  the  tooth  and  danger  to  the  enamel  are 
too  great  to  be  risked.  Cut  the  band  by  grinding  it  with  a  suit- 
ably-shaped wheel,  carefully  supporting  the  tooth  at  the  same  time. 


LIGATURES.  I7 

Section  II.     Ligatures. 

Of  the  various  materials  employed  for  ligatures  I  now  use  but 
three.  First,  the  rubber  ligature,  which  is  best  made  by  punching 
with  a  rubber-dam  punch  a  hole  through  heavy  rubber-dam,  or  in 
a  thin  elastic  band,  and  then  trimming  the  outside  down  to  the 
desired  size;  second,  waxed  floss  silk;  third,  wire.  Each  possesses 
advantages  in  certain  cases,  but  on  account  of  the  cleanliness, 
strength,  and  ease  with  which  force  may  be  exerted  by  twisting  its 
ends,  the  wire  ligature  is  decidedly  preferable.  The  proper  sizes 
of  wire  are  Nos.  26  and  28,  and  it  should  be  annealed  brass.  It 
may  be  procured  of  any  wholesale  hardware  dealer,  or  will  be  sup- 
plied if  desired.     Spring  wire  will  not  answer. 

The  best  way  to  adjust  a  wire  ligature  is  to  cut  a  piece  from 
the  spool,  eight  or  ten  inches  long,  or  sufificient  to  be  grasped 
firmly  with  the  hands.  It  is  made  to  encircle  the  tooth  and  arch 
by  passing  it  through  the  interdental  spaces.  The  ends  are 
grasped  firmly,  drawn  around  the  tooth  and  appliance,  and  twisted, 
— never  more  than  three-quarters  of  a  circle  at  first.  The  surplus 
wire  is  then  cut  ofT  with  the  shears  (C,  Fig.  8  A),  leaving  the  ends 
one-eighth  of  an  inch  long,  then  curling  them  around  under  the 
arch,  as  shown  correctly  only  in  Figs.  28,  67,  and  yT^.  It  is  very 
important  that  this  point  be  remembered,  for  by  observing  this 
special  way  of  providing  for  the  sharp  ends,  a  smooth,  easy  sur- 
face is  presented  to  the  lip.  Never  attempt  to  bend  the  twisted 
portion  of  the  ligature  out  of  the  way,  as  by  so  doing  the  ligature 
will,  in  almost  every  instance,  be  broken.  In  tightening  the  liga- 
ture, I  find  a  very  excellent  plan  is  to  gently  press  the  tooth  and 
arch  between  the  roughened  beaks  of  pliers  B,  Fig.  8  A,  while  the 
twist  is  being  made  with  pliers  A,  Fig.  8  A.  Great  force  should 
never  be  exerted  in  twisting  the  wire,  or  breaking  will  surely  fol- 
low. It  should  also  be  remembered  that  the  spring  of  the  wire 
arch,  when  used  in  connection  with  the  wire  ligature,  is  constantly 
acting,  so  that  as  a  rule  tightening  a  ligature  should  be  done  only 
occasionally. 

The  different  styles  of  ligatures  are  well  shown  in  Fig.  28,  and 
should  be  carefully  studied. 


THE   ANGLE   SYSTEM, 
Fig.  8  A. 


LIGATURES. 


19 


Fig.  8  B. 


20  THE   ANGLE    SYSTEM. 

CHAPTER    III. 

TOOLS. 

For  uniting  the  different  parts  of  the  apphances  to  form  the 
various  combinations,  and  placing  them  in  position  upon  the  teeth, 
only  a  few  tools  are  necessary,  but  it  is  important  that  they  should 
be  of  the  best  selection.  A  pair  of  shears,  C,-  Fig.  8  A,  for  trim- 
ming soldered  bands  and  cutting  wire  ligatures,  etc.  A  pair  of 
pliers,  E,  Fig.  8  A,  used  in  holding  bands  and  some  of  the  small 
parts  while  soldering,  is  the  most  suitable  of  any  made,  on  account 
of  their  fine,  delicate  proportions.  Coarse  pliers  should  never  be 
used,  as  they  absorb  too  much  heat,  and  with  them  fine,  delicate 
soldering  cannot  be  accomplished  without  danger  of  overheating. 

A  second  pair,  D,  Fig.  8  A,  for  placing  pieces  of  the  solder  in 
position.  A  pair  of  wire-cutters;  I  prefer  the  style  shown  in  F, 
Fig.  8  A. 

Two  pairs  of  pliers  for  forming  the  plain  band,  twisting  wire 
ligatures,  etc.  Those  shown  at  A  and  B,  Fig.  8  A,  are  most  ex- 
cellently adapted. 

H,  Fig.  8  B,  shows  the  author's  forceps  for  stretching  wire, 
which  will  be  found  very  useful  in  the  regulation  of  teeth.  Its 
peculiar  form  renders  it  easy  of  application  in  any  part  of  the 
mouth.  It  is  adapted  to  the  wire  G,  Set  No.  i,  and  should  never 
be  used  for  stretching  hard  or  large-sized  wires.  A  little  experi- 
ence in  its  use,  and  the  operator  will  become  skillful,  and  will  prob- 
ably be  surprised  to  see  how  much  can  be  accomplished  in  the 
regulation  of  teeth  by  its  use.  A  little  anvil  is  also  quite  useful, 
and  the  very  handy  and  ingeniously  constructed  pattern  shown  at 
K,  Fig.  8  B,  will  be  found  the  most  suitable. 


CHAPTER    IV. 

SOLDERING. 


In  uniting  the  parts  of  the  appliances  with  solder,  a  fine,  sharp 
flame  from  a  stationary,  self-acting  blow-pipe  is  most  desirable,  as 
then  both  hands  are  free  and  can  be  used  in  holding  the  pieces. 
Notwithstanding  many  ingenious  spring-clamps  and  devices  have 


SOLDERING.  21 

been  invented  for  holding  such  small  work  while  soldering,  yet  I 
greatly  prefer  holding  them  with  the  fingers,  as  it  is  so  much 
easier  and  simpler,  steadying  the  hands  by  touching  the  fingers 
together,  as  shown  in  Figs.  9  and  10. 

The  metal  of  which  these  appliances  are  made  is  most  favorable 
for  soldering  in  this  way,  it  being  so  extremely  poor  a  conductor 
of  heat  that  all  such  attachments  as  E,  F,  I,  H,  and  K,  Fig.  20,  can 
readily  be  held  with  the  fingers  without  hardly  noticing  a  change 
in  the  temperature,  provided  the  flame  is  suitable.  I  prefer  the 
Herapath  blow-pipe,  as  shown  in  G,  Fig.  8  B,  A  building  where 
compressed  air  is  furnished  and  conducted  through  pipes  to  all 
rooms,  the  same  as  gas,  the  pressure  being  constant,  even,  and 
steady,  is  preferable;  yet  the  ordinary  foot-bellows  answers  very 
well. ' 

Fig.  9. 


All  the  small  tubes  are  best  held  by  slipping  them  on  to  the  end 
of  an  excavator  shank  or,  what  is  just  the  ideal,  one  of  Gates's 
nerve-drills  after  the  cutting-point  has  been  broken  off.  It  is  so 
slender  that  but  little  of  the  heat  is  absorbed.  Two  of  these 
handles  may  be  employed  when  a  couple  of  the  small  tubes  are 
soldered,  as  R,  C,  Fig.  44,  or  the  pliers  may  be  used  for  holding 
one  of  them.     (See  Fig.  10.) 

I  should  judge  it  not  difficult  to  learn  this  method  of  soldering, 
as  most  of  my  students  seem  to  learn  it  readily.  The  only  point 
which  at  all  may  perplex  the  beginner  is  to  hold  the  pieces  im- 
movable just  at  the  time  solder  is  congealing,  but  this  can  be  done 
by  touching  the  fingers  of  the  opposite  hand  in  order  to  steady  and 
prevent  all  motion  at  the  point  of  union,  and  at  the  same  time 
holding  the  pieces  gently,  not  rigidly,  just  as  a  good  penman  holds 
a  pen.  After  a  little  practice  any  of  the  combinations  shown  in 
this  !)Ook  mav  be  casilv  made  in  a  vcrv  few  minutes.     All  of  the 


22 


THE   ANGLE    SYSTEM. 


various  attachments  by  solder  shown  in  Figs.  20  and  21  are  made 
in  this  way.  In  such  attachments  as  E,  F,  H,  and  K,  Fig.  20,  the 
pieces  of  solder  may  be  kept  from  flying  off  by  gently  holding 
them  in  position  between  the  pieces  to  be  united.  But  where  the 
ends  of  small  tubes  are  to  be  secured  as  in  C  and  D,  it  is  best  to 
first  use  the  solder  upon  the  band,  and  then  hold  the  small  tubes 
by  means  of  the  soldering  pliers  in  contact  with  the  solder  and 
again  apply  heat,  otherwise  the  solder  will  be  drawn  into  the  tube. 
The  solder  best  adapted  in  uniting  the  different  parts  of  these 
appliances  is  the  ordinary  jeweler's  silver  solder,  although  any  of 
the  gold  solders  work  equally  as  well.     Plenty  of  borax  should 


Fig.  10. 


always  be  used  as  a  flux.  Never  use  more  solder  than  is  necessary, 
especially  in  attaching  the  small  tubes;  use  just  sufficient  to  make 
the  union. 

Always  avoid  overheating;  just  enough  heat  from  a  small  flame 
to  thoroughly  fuse  the  solder  is  all  that  should  ever  be  employed. 
In  every  instance,  avoid  heating  the  screws  or  nuts.  This  is  to  be 
especially  observed  with  the  jack  and  traction-screws,  as  great  care 
is  observed  in  their  manufacture  to  produce  the  greatest  stiffness 
and  strength,  and  this  fine  temper  is  ruined  by  heating.  The  wire 
arches  B  and  E  are  also  manufactured  in  such  a  way  as  to  give 
to  them  the  greatest  possible  spring,  second  only  to  steel.  They 
must  not  be  heated,  or  this  delicate  temper  will  be  destroyed. 

The  three  delicate  sheaths  found  on  the  wire  arch  B,  Set  No.  2, 
are  attached  by  means  of  soft  solder.  Should  one  of  them  become 
loosened  it  may  be  resoldered,  using  the  soft  solder  and  a  drop  of 
muriatic  acid,  and  applying  a  fine  flame,  carrying  the  heat  to  only 
just  the  point  sufficient  to  fuse  the  solder. 

Where  two  or  more  bands  are  to  be  united  in  order  to  retain  the 


IMPRESSION    AND    MODEL    MAKING.  23 

teeth,  as  in  Fig.  54,  they  should  be  gently  held  by  their  untrimmed 
ends  while  being  soldered,  as  in  Fig.  11,  after  which  they  are 
trimmed  with  the  shears. 

Fig.  II. 


%.  ^-^ 


CHAPTER    V. 

IMPRESSION  .AND  MODEL  MAKING. 

In  deciding  upon  the  proper  course  of  treatment  in  any  given 
case,  it  is  of  the  first  importance  to  obtain  very  accurate  articulat- 
ing models  of  both  arches.  Such  models  not  only  assist  in  form- 
ing a  basis  for  correctly  establishing  the  proper  line  of  operation, 
but  are  exceedingly  valuable  as  references  during  the  whole  course 
of  treatment,  for  from  such  models  accurate  measurements  may 
be  taken  from  time  to  time,  and  comparisons  be  made  as  the  case 
progresses.  In  this  way  one  may  not  only  judge  of  the  exact 
speed  of  the  moving  teeth,  but  any  unfavorable  movements  of  the 
anchor  teeth  may  be  detected. 

In  order  that  these  models  may  be  of  real  value,  they  must  not 
only  accurately  show  both  arches  and  the  relative  positions  of  the 
teeth  and  cusps,  and  also  the  vault  of  the  arch,  rugae,  and  gums, 
but  must  correctly  show  as  much  of  the  roots  and  positions  of  the 
same,  as  indicated  by  the  gums  and  alveoli,  up  to  the  point  where 
the  attachments  of  the  muscles  render  obscure  the  further  shape  of 
the  jaw.  Such  models  can  only  be  made  from  impressions  taken 
in  plaster. 

From  the  large  number  of  imperfect  models  which  I  receive 
each  year  from  dentists,  I  am  of  the  opinion  that  the  value  of  cor- 
rect models  is  not  suflFiciently  appreciated. 


24 


THE    ANGLE    SYSTEM. 


If  the  reader  will  carefully  follow  the  following  simple  plan  for 
taking  impressions  and  making  models  he  will  find,  after  a  little 
experience,  that  the  method  is  both  natural  and  easy,  and  the  most 
beautiful  results  certain.  He  must,  however,  observe  accuracy  in 
each  stage  of  the  operation. 

First,  the  teeth  should  be  thoroughly  cleansed  from  all  tartar  or 
soft  deposits.  For  this  the  little  rubber  cup  disk  used  with  pumice 
is  most  excellent.  Care  should  be  taken  not  to  wound  the  gums, 
as  any  bleeding  prevents  accuracy  of  impression. 

The  trays  shown  at  Fig.  12  are  essential.  They  were  especially 
designed  for  taking  impressions  of  complete  or  partial  arches,  and 
must  always  be  kept  thoroughly  smooth,  bright,  and  clean. 

Fig.  12. 


Author's  Improved  Impression-Travs. 


Good  impression  plaster  is  mixed  in  the  usual  way  and  care- 
fully distributed,  as  shown  in  Fig.  I2,i,  the  shape  and  height  of  the 
trays  making  but  little  impression-material  necessary. 

It  will  be  observed  that  the  greater  amount  is  placed  in  the 
anterior  part  of  the  tray  and  made  to  extend  over  the  outer  edge 
of  the  rim,  none  being  allowed  in  the  vault  of  the  tray.  It  is  now 
placed  in  position  and  allowed  to  rest  evenly  in  contact  with  the 
cutting  edges  of  all  the  teeth.  The  lip  is  then  raised  and  the 
plaster  extending  outside  the  rim  is  carried  high  up  underneath  it 
zvith  the  finger;  then  the  tray  is  forced  up  evenly  until  the  points  of 
Hie  teeth  touch,  or  nearly  touch,   the   bottom  of  the  tray,   and 


IMPRESSION    AND    MODEL    MAKlNt;.  25 

steadily  supported  on  the  end  of  the  index  finger  only.  To  expel 
the  air,  the  lip  and  cheeks  are  now  gently  manipulated,  but  not 
drawn  down,  as  to  do  so  would  expel  a  portion  of  the  plaster  and 
prevent  one  of  the  important  objects,  viz,  a  very  high  impression. 

Fig.  13. 


As  no  surplus  plaster  could  have  been  forced  in  contact  with  the 
soft  palate,  causing  nausea,  the  patient  will  not  be  inconveniencetl, 
and  the  impression  may,  therefore,  be  allowed  to  remain  until  it  has 

Fig.  13^2. 


become  thoroughly  set.  '{"he  harder  the  plaster  is  allowed  to  set 
the  more  perfect  will  be  the  impression.  (If  removed  too  quickly, 
portions  of  the  plaster  will  be  found  adhering  to  the  surfaces  of  the 
teeth.) 


26  THE  ANGLE  SYSTEM. 

The  tray  must  now  be  loosened  and  taken  away,  leaving  the 
impression  in  the  mouth.  All  superfluous  pieces  should  be  re- 
moved very  carefully.  Two  grooves  are  then  scraped  or  cut  in 
the  hardened  plaster  on  a  line  parallel  with  the  cuspid  teeth,  never, 
however,  cutting  quite  through.  Then,  with  a  quick  pry  with  the 
point  of  a  pen-knife,  the  anterior  plate  is  wrenched  loose  and  laid, 
together  with  all  subsequent  pieces,  on  a  clean  blotting  pad.  The 
lateral  pieces  are  then  broken  off  between  the  thumb  and  finger, 
when  the  large  piece  covering  the  roof  of  the  mouth  alone  will 
remain.  This  may  be  readily  worked  loose,  and,  if  the  operation 
has  been  carefully  performed,  the  impression  will  then  consist  of 
four  pieces  (although  a  greater  number  will  in  no  way  injure  it). 
Great  care  should  be  observed  to  save  all  small  pieces,  removing 
them  as  clean  as  possible. 

Patience  and  care  should  be  observed  in  re-uniting  the  pieces. 
If  skillfully  done  the  line  of  fracture  can  hardly  be  detected.  The 
pieces  are  best  united  out  of  the  tray  and  held  with  wax  made  quite 
hot  on  the  spatula  and  flow^ed  over  the  outside,  the  clean,  united 
ends  being  held  so  perfectly  in  contact  that  little  if  any  will  flow 
into  the  fracture.  When  finished  it  should  have  the  appearance 
illustrated  in  Fig.  13.  If  there  be  an  unusual  number  of  pieces 
they  may  be  united  by  replacing  them  in  the  tray,  but  this  is  never 
very  accurate,  as  the  expansion  of  the  plaster  makes  a  perfect  fit 
with  the  tray  impossible. 

This  method  of  taking  impressions  preserves  the  fine  points  of 
the  interdental  spaces.  I  believe  it  to  be  the  only  practicable  way 
of  taking  an  accurate  impression. 

In  like  manner  the  impression  of  the  lower  arch  is  secured, 
being  careful  to  observe  the  essential  points,  namely,  carrying  the 
impression-material,  which  has  been  built  up  and  outside  of  the 
anterior  part  of  the  rim,  well  down  beneath  the  lip  zvith  the  Hnger 
before  forcing  the  tray  home,  then  expelling  the  air  by  gradually 
working  the  cheeks  while  the  tray  is  firmly  held.  Care  should  be 
observed  in  selecting  a  sufficiently  large  tray  which  may,  without 
injury,  be  bent  to  conform  more  perfectly  to  any  peculiar  shape  of 
the  arch. 

After  the  impression  has  been  thoroughly  dried  the  inside  should 
be  coated  with  shellac  varnish  ;  at  the  expiration  of  half  an  hour  it 
is  again  coated  with  sandarac  varnish,  and  at  the  end  of  another 
half-hour  it  should  be  very  carefully  filled  with  plaster. 

It  is  important  that  both  of  these  varnishes  shall  be  of  the  proper 
consistence,  which  it  is  difficult  to  describe.     If  too  thin  it  will  be 


IMPRESSION    AND    MODEL    MAKING.  27 

difficult  to  separate  the  impression  without  injury  to  the  model. 
If  too  thick  all  fine  tracings  of  the  impression  will  be  obliterated. 
The  proper  consistence  is  best  determined  by  a  little  experience. 
The  filling  of  the  impression  with  plaster  is  best  accomplished 
by  applying  the  soft  plaster  into  the  tooth  cavities  by  means  of  a 
small  camel's-hair  brush  in  order  to  expel  all  air-bubbles,  then 
filling  the  remainder  by  means  of  the  spatula;  then  it  should  be 
turned  upside  down  on  a  glass  slab. 

After  the  plaster  has  thoroughly  set,  the  pieces  of  the  impres- 
sion may  usually  be  very  readily  separated  in  the  same  order  in 
which  they  were  removed  from  the  mouth,  when,  should  any  air- 
cavities  be  found  in  the  model,  they  may  be  beautifully  filled  by 
packing  in  white  oxyphosphate  of  zinc  and  pressing  it  home  by 
replacing  the  piece  of  the  impression,  which  should  be  allowed  to 
remain  until  the  cement  is  thoroughly  hardened,  when  it  will 
readily  separate,  leaving  a  very  perfect  surface.  A  cusp  or  broken 
tooth  may  in  like  manner  be  repaired. 

The  models  may  now  be  trimimed,  and  not  only  will  there  be  a 
surface  as  smooth  as  polished  marble,  but  each  cusp,  all  the  inter- 
dental spaces,  the  rugae  as  well  as  the  inclination  of  the  roots, 
and  even  the  minute  "stipples"  of  the  gum,  will  all  be  accurately 
and  beautifully  shown.  Any  coatings  of  paints  or  varnishes  only 
detract  from  the  beauty  of  such  models. 

They  should  now  be  carefully  articulated,  after  comparison 
with  the  natural  teeth  and  the  articulation,  indicated  by  two  or 
more  pencil  markings,  so  the  proper  points  of  contact  may  be 
afterward  readily  found.  These  serve  the  purpose  quite  as  well 
as  a  metal  articulator.  The  models  should  also  be  neatly  labeled 
to  serve  for  study  and  reference,  and,  on  occasion,  be  valuable  as 
legal  evidence. 

As  soon  as  the  teeth  have  been  completely  moved,  another  im- 
pression should  be  taken  and  models  made.  This  is  done  after 
all  appliances  have  been  removed,  the  teeth  thoroughly  cleansed, 
and  immediately  previous  to  adjusting  the  retaining  appliances. 
These  models  are  valuable  for  comparison  with  the  natural  teeth 
during  the  period  of  retention,  as  well  as  for  future  reference. 

It  is  also  of  advantage  to  have  study  models  occasionally  made 
during  treatment  and  retention,  by  pressing  a  piece  of  softened 
wax,  about  three-eighths  of  an  incii  deep,  onto  the  cutting  edges 
of  the  teeth,  to  accurately  show  the  positions  of  the  teeth  only, 
together  with  such  appliances  as  may  bo  upon  them. 


26 


THE    ANGLE    SYSTEM. 


CHAPTER    VI. 

DIRECTION   OF   FORCES   FOR  TOOTH-MOVEMENT. 

In  the  correction  of  dental  irregularities,  an  appliance  must  act 
either  by  pulling,  pushing,  or  twisting  a  tooth  into  proper  position ; 
and  the  movements  of  the  tooth  are  limited  to  seven:  backward  or 
forward  in  the  line  of  the  arch,  outward  or  inward  in  the  line  of 
the  arch,  elongation  or  depression  of  the  tooth  in  its  socket,  and 
rotation. 

Section  I.     Backward  in  the  Line  of  the  Arch. 

The  backward  movement  of  the  teeth  in  the  line  of  the  arch  is 
accomplished  in  two  principal  ways.  First,  by  the  large  traction- 
screw  A  and  D,  Set  No.  i,  shown  in  Fig.  14,  for  the  retraction  of  a 


Fig 


Retraction  of  Cuspid. 

superior  cuspid.  The  first  molar  is  encircled  by  a  No.  2  clamp- 
band  (Fig.  6),  to  which  is  soldered  the  long  sheath  of  the  traction- 
screw  A,  Fig.  I.  The  cuspid  is  also  encircled  by  a  band,  having 
the  short  tube  D,  Set  No.  i,  soldered  horizontally  to  it  on  its  distal 
surface,  with  which  tube  the  smooth  bent  end  of  the  traction-screw 
engages.  The  nut,  operating  against  the  distal  end  of  the  tube, 
will  move  the  cuspid  backward  into  position.  The  easiest  way  to 
adjust  this  appliance  is  to  first  cement  the  band  upon  the  cuspid; 
after  the  cement  has  become  thoroughly  set,  the  angle  of  the 
traction-screw  is  hooked  into  the  short  tube,  and  the  adjustable 
band  latched  over  the  molar.  It  is  very  important  that  the  bent 
end  be  passed  into  the  tube  its  full  length,  otherwise  it  will  be 
broken  when  force  is  exerted.     The  screw  may  be  employed  on  the 


DIRECTION    OF    FORCES    FOR   TOOTH-MOVEMENT. 


29 


outside  of  the  arch;  the  short  tube,  in  that  event,  should  be  at- 
tached to  the  mesio-buccal  angle  of  the  band,  as  shown  on  the 
right  cuspid  of  Fig.  15. 

If  a  movement  of  rotation  as  well  as  retraction  is  desirable,  the 
angle  of  the  screw  should  be  hooked  over  a  spur,  as  shown  on  the 


Ktc 


left  cuspid  of  Fig.  15,  thus  concentrating  all  the  force  upon  one 
side  of  the  moving  tooth.  Recent  experience  has  shown  that  a 
staple  made  from  the  wire  G,  Set  No.  i,  is  stronger  and  better  than 
the  spur  for  making  this  attachment.  Should  the  cuspid  be  very 
prominent,  requiring  the  movement  to  be  inward  as  well  as  back- 
ward, that  may  be  accomplished  at  the  same  time  by  bending  the 
screw,  which,  as  the  nut  is  turned,  will  be  gradually  straightened. 
(See  Fig.  16.) 

Fig.  16. 


A  method  of  reinforcing  the  anchor-tooth  is  also  shown  in  this 
engraving,  by  enlisting  the  resistance  of  the  lateral  incisor.  This 
tooth  is  banded  and  provided  with  one  of  the  pipes  R,  Set  No.  i, 
soldered  to  its  distal  angle;  one  end  of  a  piece  of  the  wire  G,  Set 
No.  I,  is  soldered  to  the  sheath  of  the  traction-screw,  and  made  to 
rest  in  this  pipe. 

In  making  the  attachments  for  retraction  after  the  manner  dc- 


30 


THE    ANGLE    SYSTEM. 


scribed,  it  is  of  the  utmost  importance  that  the  band  encircling  the 
molars  should  be  tightly  clamped,  burnished,  and  firmly  cemented, 
so  that  the  attachment  will  be  perfectly  rigid.  In  this  way  the  re- 
sistance of  the  anchorage  will  be  greatly  increased,  and  tipping  of 
the  anchor-teeth  will  be  prevented;  while,  if  moved  at  all,  they 
must  be  dragged  bodily  through  the  alveolus,  because  the  apices 
of  the  roots  move  equally  with  the  crown,  as  shown  in  Fig.  17, 


Fig.  17. 


Stationary  Anchorage. 

which  represents  a  side  view  of  the  appliance  in  position,  the 
dotted  lines  showing  the  movements  which  must  take  place  if  the 
attachment  is  properly  made.  This  is  a  most  perfect  form  of 
anchorage,  and  I  am  indebted  to  Dr.  W.  C.  Barrett  for  first  sug- 
gesting it. 

If  the  nut  is  placed  upon  the  screw  in  front  of  the  sheath  and 
tightened,  force  with  the  same  resistance  of  anchorage  may  be 


Fig.  18. 


>ir:-- 


'Mf.-:^.  iV'^:^?; 


exerted  in  moving  the  tooth  forward  instead  of  backward.  When 
the  jack-screw  is  employed  for  pushing,  the  same  firmness  of 
anchorage  may  be  gained  by  soldering  the  base  of  the  sheath  to 
the  anchor-band,  which  is  to  be  firmly  clamped  and  cemented  in 
position  upon  the  anchor-tooth,  as  shown  in  Fig.  18. 

Another  way  of  moving  teeth  backward  in  the  line  of  the  arch 
is  by  means  of  Set  No.  2,  and  will  be  described  in  the  treatment  of 
cases  of  excessive  protrusion  of  the  superior  incisors. 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT.  3I 

Section  II.     Forward. 

The  movement  of  a  tooth  forward  in  the  Hne  of  the  arch  may 
be  accompHshed  by  means  of  the  traction-screw,  in  the  same  way 
as  already  described  for  retraction,  by  selecting  anchor-teeth  on 
the  opposite  side  to  be  used  in  overcoming  the  resistance  of  the 
tooth  that  is  being  moved,  as  shown  in  Fig.  19,  which  represents 

Fig.  19. 


a  case  in  practice,  and  shows  the  screw  employed  in  pulling  both 
incisors  forward  in  the  line  of  the  arch  to  close  the  wide  space 
between  the  centrals;  at  the  same  time  providing  space  for  the 
cuspid,  which  is  being  moved  out  of  inlock  by  means  of  the  jack- 
screw.  In  this  case  the  traction-screw  was  beaten  flat,  polished, 
and  bent  to  conform  to  the  curve  of  the  arch. 


Section  III,     Outward. 

The  movement  of  a  tooth  from  within  outward  into  the  line  of 
the  arch  is  accomplished  in  four  principal  ways:  First,  by  means 
of  the  jack-screw  E  and  J,  Set  No.  i,  the  sheath  of  which  is  secured 
to  a  suitable  anchor-tooth,  the  point  acting  upon  the  moving  tooth 
by  turning  the  nut.  The  base  of  the  sheath  of  the  jack-screw  may 
be  secured  in  various  ways,  as  shown  in  Fig.  20.  First  by  a  dowel 
made  by  soft-soldering  a  piece  of  the  wire  G,  Set  No.  i,  into  the 
end  of  the  sheath  which  rests  in  a  pit  in  the  anchor-tooth,  as  in  A. 
By  a  spur  made  from  the  same  wire  soldered  to  the  anchor-band, 
over  which  the  end  of  the  sheath  is  slipped,  as  in  B.  By  a  dowel 
made  from  the  same  wire,  slipped  into  one  of  the  pipes  R,  Set  No. 
I,  soldered  to  the  anchor-band,  as  in  C.  (In  this  way  the  length 
of  the  sheath  may  also  be  increased.)  By  pointing  the  end  of  the 
sheath  with  a  file  and  letting  the  point  rest  in  the  pipe  on  the 
anchor-band,  as  in  D,  By  soldering  the  sheath  directly  to  the 
anchor-band,  as  in  E  and  F,     By  notching  the  end  of  the  sheath, 


32 


THE    ANGLE    SYSTEM. 


which  shall  engage  the  anchor-wire  as  in  G,  Fig.  20,  and  Fig.  41. 
By  soldering  the  end  of  the  sheath  directly  to  another  sheath,  as  in 
H.  By  means  of  a  spur  made  from  the  wire  G,  Set  No.  i,  soldered 
to  the  sheath  which  shall  engage  one  of  the  pipes  R,  Set  No.  i, 
soldered  to  the  anchor-band,  as  in  I.  By  slipping  the  end  of  the 
sheath  over  the  screw  upon  the  clamp-band,  as  in  J.     Of  these 


Fig.  20. 


various  ways  I  prefer  that  of  attaching  the  sheath  directly  to  the 
anchor-band,  as  in  E  and  F,  or  by  means  of  the  spur,  as  in  B  (the 
spur  being  quickly  and  easily  made  by  soldering),  by  holding  a 
long  piece  of  the  wire  G,  Set  No.  i,  between  two  of  the  fingers  of 
one  hand,  while  the  end  of  the  screw  upon  the  clamp-band  is 
grasped  between  the  thumb  and  finger  of  the  other  hand,  carrying 
it  in  contact  with  the  fine  point  of  the  flame  (as  in  Figs.  9  and  10), 
presenting  the  appearance  after  soldering  shown  in  K,  Fig.  20; 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


33 


after  which  the  wire  is  cut  off,  leaving  the  desired  length  of  the 
spur.  The  point  of  the  screw  is  held  firmly  in  position  by  six 
principal  ways,  as  shown  in  Fig.  21, 

First:  By  notching  the  point  of  the  screw  with  a  separating 
file,  which  notch  will  engage  a  similar  notch  in  the  united  ends 
of  the  band,  as  in  A.  By  pointing  the  end  of  the  screw  to  engage 
one  of  the  small  pipes  R,  Set  No.  i,  soldered  to  the  band  as  in  B. 
By  a  mortise  in  the  band  to  engage  the  point  of  the  screw,  as  in  C. 
By  soldering  an  elliptical  ring  (formed  by  bending  the  wire  G, 
Set  No.  I,  as  at  G,  Fig.  21),  in  which  to  rest  the  point  of  the  screw, 
as  in  D.  By  a  staple,  made  from  the  same  wire,  soldered  (see  H) 
to  the  band,  as  in  E,  the  point  of  the  screw  being  suitably  notched. 


I       '^,        I 


By  pointing  the  screw  to  be  received  in  the  pit  formed  in  the 
enamel  or  filling,  as  in  F.  Of  these  various  ways  of  securing  the 
point  of  a  jack-screw,  I  prefer  the  plan  shown  in  D  and  E,  forming 
the  ring  and  staple  upon  the  ends  of  long  pieces  of  the  wire,  which 
serve  as  handles  while  soldering,  as  in  G  and  H,  after  which  the 
superfluous  portions  are  clipped  ofif.  The  roughened  ends  are 
then  rounded  and  made  smooth  with  a  fine  file. 

Fig.  22  shows  an  inlocked  cuspid  being  moved  outward,  the 
point  of  the  screw  resting  in  a  mortise  formed  in  the  band  upon 
the  moving  tooth,  the  base  of  the  sheath  being  notched  to  engage 
a  piece  of  the  anchor-wire  G,  Set  No.  i,  passing  through  a  tube 
soldered  to  the  lingual  surface  of  the  left  cuspid.  The  anchor- 
age is  greatly  reinforced  by  means  of  this  wire,  which  is  beaten 
flat  where  it  passes  between  the  central  and  lateral,  the  end  being 


34 


THE   ANGLE    SYSTEM. 


bent  around  the  labial  surface  of  the  central.  Force  is  obtained 
by  turning-  the  nut.  After  a  tooth  has  been  moved  into  the 
desired  position,  it  is  retained  by  a  piece  of  the  wire  G,  Set  No.  i, 
passed  through  a  pipe  R,  Set  No.  i,  soldered  to  the  band,  the  wire 
ends  resting  upon  the  labial  surfaces  of  the  lateral  incisor  and 

Fig.  22. 


Fig.  23. 


Fig.  24. 


first  bi'^uspid.     This  wire  is  held  in  place  by  a  very  delicate  pin 
passing  through  the  pipe  and  one  side  of  the  wire,  as  in  Fig.  23. 

Fig.  24  shows  a  favorite  method  of  reinforcing  the  anchorage. 
In  this  case  the  sheath  of  the  jack-screw  was  placed  on  a  spur 
soldered  to  a  bicuspid  clamp-band,  as  at  B,  Fig.  20.  The  point 
of  the  screw  was  sharpened  and  rested  in  a  pit  formed  in  the 


DIRECTIOX    OF    FORCES    FOR    TOOTH-MOVEMENT.  35 

enamel.  Reinforcement  was  gained  by  hooking  a  piece  of  the 
wire  G,  Set  No.  i,  into  two  pipes  (R,  Set  No.  i),  one  soldered  to 
the  sheath  of  the  jack-screw  near  its  base,  the  other  soldered  to 
the  lingual  surface  of  a  lateral  incisor  band.  If  the  appliance  has 
been  carefully  adjusted  the  patient  may  be  provided  with  a  wrench, 
and  instructed  in  turning  the  nuts  at  proper  intervals. 

Recent  experience  has  proven  that  an  easier  way  of  attaching 
the  reinforcement  wire  is  to  omit  the  pipe  attached  to  the  band 
on  the  lateral,  soldering  the  straight  end  of  the  wire  directly  to 
the  band.  The  other  end  of  the  wire  should  be  passed  straight 
through  the  pipe,  on  the  sheath,  and  secured  by  bending  the  end 
around  the  pipe  end. 

Fig.  25  shows  a  left  lateral  being  moved  outward,  reinforcement 
having  been  gained  in  the  manner  already  described,  using  two 

Fig.  2;. 


pieces  of  wire  attached  to  bands  on  the  central  and  cuspid.  Not 
only  was  the  anchorage  reinforced,  but  the  incisor  and  cuspid  were 
prevented  from  being  pushed  out,  the  moving  tooth  providing 
space  for  itself  by  forcing  the  adjoining  teeth  laterally.  By  this 
means  the  most  perfect  form  of  anchorage  is  secured,  employing, 
preferably,  the  method  of  attaching  the  reinforcement  wires  de- 
scribed in  the  last  case. 

The  second  mode  of  moving  a  tooth  from  within  outward  is 
shown  in  Fig.  25,  where  a  right  lateral  is  being  forced  outward 
by  means  of  the  stnall  traction-screws  B  and  C,  Set  No.  i.  A 
strip  of  the  band-material  (F,  Set  No.  i)  is  looped  around  the 
lateral,  the  ends  resting  upon  the  labial  surfaces  of  the  adjoining 
teeth.  On  one  end  is  soldered  a  short  tube,  C  (accompanying 
the  screw),  attached  vertically,  while  on  the  other  end  a  similar 
tube  is  attached  horizontally.  Into  these  tubes  the  traction-screw 
E,  Set  No.  I,  is  placed,  being  bent  to  conform  to  the  circle  of  the 
arch,  and  used,  in  this  case,  to  push  instead  of  pull.     This  appli- 


36 


THE    ANGLE    SYSTEM. 


ance  should  be  frequently  tightened  by  turning  the  nut,  or  it  will 
become  loose  and  cause  trouble.  The  parts  of  this  device  are 
shown  separately  in  Fig.  26. 

Fig.  2y  shows  the  teeth  as  retained  by  means  of  pieces  of  the 
anchor-wire  (G,  Set  No.  i)  passing  through  pipes  attached  to  the 
labial  surfaces  of  the  bands,  as  described  and  shown  in  Fig.  23. 


Fig.  26. 


Fig.  27. 


The  third  method  of  moving  a  tooth  from  within  outward  is 
by  lacing  the  teeth  to  the  expansion  arch,  as  in  Fig.  28,  force 
being  derived  from  the  spring  of  the  arch  and  sustained  by 
occasionally  turning  the  nuts.     (See  also  Fig.  68.) 

The  fourth  method  is  by  means  of  the  wire  ligature  encircling 
the  tooth  and  arch,  force  being  exerted  by  occasionally  twisting 
the  wire,  as  in  A,  A,  Fig.  28. 

Fig.  28 


Section  IV.     Inward. 


A  tooth  may  be  moved  in\yard  by  the  small  traction-screw 
B  and  C,  Set  No.  i,  as  shown  in  Fig.  29,  in  which  a  cuspid  is 
being  drawn  into  line,  the  bent  end  of  the  screw  being  hooked 
into  the  small  tube  C,  Set  No.  i,  soldered  to  the  band  upon  the 
anchor-tooth.  The  other  end  of  the  screw  passes  through  a 
similar  tube,  against  the  end  of  which  the  nut  works.  To  the 
tube  is  soldered  a  piece  of  the  wire  G,  Set  No.  i,  bent  at  right 
angles  and  hooked  into  a  pipe  (R,  Set  No.  i),  soldered  to  the 
lingual  surface  of  the  band  on  the  cuspid.  Force  is  exerted  by 
turning  the  nut.  The  anchor-tooth  was  reinforced  by  a-  piece  of 
the  wire  G,  Set  No.  i,  resting  in  contact  with  the  buccal  surfaces 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


37 


of  the  adjoining  teeth,  and  held  in  position  by  one  of  the  small 
pipes  R,  Set  No.  i.  This  anchor-wire  was  kept  from  turning 
by  a  very  delicate  pin  passing  through  the  pipe  and  one  side  of 
the  wire,  as  in  Fig.  23.  Another  way  of  securing  this  wire  is 
by  soldering  it  directly  to  the  band. 

Prominent  teeth  may  also  be  forced  into  the  line  of  the  arch 
by  means  of  the  wire  arch  B,  Set  No.  2,  or  the  expansion-arch 
E,  Fig.  4,  made  to  encircle  the  dental  arch  and  bear  against  the 
prominent  tooth,  and  the  force  may  be  intensified  by  an  inter- 
vening wedge  of  rubber.  The  adjoining  teeth  are  firmly  laced 
to  the  arch  by  means  of  wire  ligatures,  as  described  in  the  treat- 
ment of  the  case  shown  in  Fig.  65. 

Fig.  29. 


Section  V.     Rotation. 

There  are  three  principal  modes  of  rotation  by  this  system. 
First:  by  means  of  the  lever,  band,  and  tube,  as  shown  in  Fig. 
30,  which  represents  a  lateral  incisor  in  process  of  rotation.  The 
incisor  was  encircled  with  an  accurately-fitting  band  cemented  in 
position  and  having  soldered  to  it  one  of  the  small  pipes  R,  Set 
No.  I,  into  which  was  inserted  the  end  of  one  of  the  levers  L, 
Set  No.  I,  the  other  end  being  sprung  around  and  secured  to  a 
suitable  anchor-tooth.  This  attachment  of  the  end  of  the  lever 
may  be  made  in  various  ways, — either  by  being  latched  into  a 
notch  formed  in  the  united  ends  of  the  band  as  shown  in  Fig.  30, 
or  by  a  wire  ligature  made  to  encircle  the  anchor-tooth  and  lever, 
or  by  a  wire  ligature  encircling  the  button  on  the  clamp-band 
CNo.  3  or  4,  Fig.  6),  and  attached  to  the  end  of  the  lever  bent  in 
the  form  of  an  eye;  which  is  now  my  favorite  method.  The 
anchor-tooth  may  be  reinforced  by  a  piece  of  the  wire  G,  Set  No.  i, 
resting  in  contact  with  the  lingual  surface  of  the  adjoining  teeth, 
and  held  in  position  by  one  of  the  pipes  R,  Set  No.  i,  soldered  to 


38  THE   ANGLE    SYSTEM. 

the  anchor-band  as  shown.  It  will  be  seen  that  thus  a  constant, 
powerful,  rotative  force  may  be  exerted  upon  the  tooth. 

Care  should  be  exercised  that  the  lever  be  not  allowed  to  pry 
against  the  intervening  teeth,  to  force  the  tooth  outward. 

It  is  often  desirable  to  lace  one  or  more  of  the  intervening 
teeth  to  the  lever  by  means  of  the  wire  ligature,  to  prevent  over- 
lapping of  the  teeth.     The  leverage  may  be  increased  by  allowing 

Fig.  30. 


the  end  to  pass  through  the  pipe,  and  to  bear  against  the  labial 
surface  of  the  adjoining  tooth.  This  may  be  intensified  by  an 
intervening  wedge  of  rubber. 

Fig.  31  shows  the  rotated  incisor  retained  by  a  short  piece  of 
the  wire  G,  Set  No.  i,  slipped  into  the  pipe  from  the  opposite  side 
and  made  to  bear  against  the  labial  surface  of  the  central  incisor. 
There  should  also  be  soldered  a  spur  to  the  disto-lingual  angle  of 
the  band  and  made  to  bear  against  the  cuspid. 

Fig.  31. 


Retainer. 


Fig.  32  shows  two  cuspids  being  rotated  by  this  method.  It 
will  also  be  seen  that  the  lever  may  be  employed  on  the  inside  of 
the  arch,  and  in  this  case  there  was  the  advantage  of  reciprocal 
anchorage  resulting  from  the  ends  of  the  levers  acting  in  opposite 
directions  upon  the  anchor-tooth. 

In  all  similar  cases  where  the  lever  is  being  employed,  on  the 
outside  of  the  arch  it  should  be  bent  at  the  point  nearest  the  labial 
surface  of  the  cuspid,  so  as  to  concentrate  all  the  spring  in  the 
region  of  the  moving  tooth. 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT. 


39 


Second :  Rotation  may  also  be  performed,  as  shown  in  Fig.  33, 
by  means  of  the  jack-screw  E  and  J,  Set  No.  i,  secured  by  staple, 
clamp-band  and  spur,  and  pushing  against  one  side  of  the  tooth 
to  be  moved,  while  the  small  traction-screw,  attached  by  pipe  R, 
Set  No.  I,  and  piece  of  anchor-wire  G,  Set  No.  i,  soldered  to  the 

Fig.  32. 


base  of  the  sheath  of  the  jack-screw,  is  made  to  pull  upon  the  other 
side  of  the  tooth.  In  this  way  perfect  control  of  the  tooth  is 
gained,  not  only  in  rotation,  but  also  in  pushing  it  outward  or  pull- 
ing it  inward  into  the  line  of  the  arch,  according  as  the  nuts  are 
adjusted.     This  method  of  rotation  is  principally  limited  to  the 

Fig.  33. 


superior  central  incisors  or  cuspids.  It  should  be  said  tliat  because 
of  the  powerful  force  they  exert  the  nuts  should  be  turned  but 
slightly  at  each  sitting.  This  is  also  another  instance  where  use 
is  made  of  reciprocal  anchorage,  which  is  to  be  taken  advantage  of 
whenever  possible. 


40  THE    ANGLE    SYSTEM. 

Third:  Rotation  may  be  accomplished  by  exerting  force  on 
one  side  of  a  tooth  by  means  of  a  wire  Hgature  on  the  expansion- 
arch  E,  and  a  spur  soldered  to  a  band  encircling  the  tooth  to  be 
moved,  as  at  B,  Fig.  28.  This  force  may  be  intensified  by  a  wedge 
of  rubber  stretched  between  the  band  and  arch  and  acting  upon 
the  opposite  side  of  the  tooth,  as  in  Fig.  68.  A  modification  of 
this  plan  of  rotation  is  shown  at  C,  Fig.  28,  in  which  the  band  is 
dispensed  with  and  the  double  or  loop  ligature  is  continued 
around  the  tooth,  including  the  wire  arch.  This  plan  is  less 
certain  on  account  of  the  liability  to  slip:  it  is  also  less  powerful, 
since  the  wedge  of  rubber  cannot  be  used.  It,  however,  will  be 
found  useful  where  teeth  are  to  be  but  slightly  rotated.  At  the 
same  time  a  number  of  other  teeth  should  be  ligatured  to  the  arch 
to  secure  greater  firmness. 

Section  VI.     Double  Rotation. 

When  two  teeth  are  to  be  rotated  in  opposite  directions  at  the 
same  time,  as  the  central  incisors  shown  in  Fig.  34,  double  rota- 

FiG.  34.  Fig.  35. 


Double  Rotation. 

tion  may  be  accomplished  by  a  single  lever.  In  this  instance  both 
the  teeth  are  banded,  and  a  tube  soldered  to  each  band.  A 
straight  lever  is  inserted  in  one  tube,  springing  and  sliding  it  into 
the  other  tube  in  the  same  manner  in  which  a  door-bolt  is  slid 
into  position,  as  also  shown  in  Fig.  35.  It  may  be  necessary  to 
occasionally  remove  and  straighten  the  lever  a  little,  in  order  to 
maintain  the  pressure.  Should  one  tooth  be  rotated  sufficiently 
before  the  other,  further  movement  may  be  arrested  by  removing 
the  band  and  soldering  a  lug  on  the  lingual  surface  to  rest  against 
the  lateral  incisor.  And  should  the  teeth  in  rotation  assume  too 
much  prominence,  by  reason  of  pressure  from  the  adjoining  teeth, 
it  may  be  effectually  corrected  by  requiring  the  patient  to  wear, 
for  a  few  nights,  the  head-gear,  traction-bar,  and  heavy  elastic 
bands  shown  in  Figs.  2  and  3,  filing  a  deep  notch  in  the  end  of 
the  standard  to  engage  the  rotating  lever. 

If  the  teeth  show  a  tendency  to  separate  as  they  rotate,  they 
should  be  drawn  tightly  together  by  a  ligature,  made  to  encircle 


DIRECTION    OF    FORCES    FOR   TOOTH-MOVEMENT.  4I 

both  tubes  and  held  in  position  by  the  ends  of  the  lever,  slightly 
protruding  through  the  tubes. 

When  the  teeth  are  in  position  they  are  retained  by  .substituting 
a  piece  of  the  non-elastic  wire  G,  Set  Xo.  i,  for  the  spring  wire, 
or,  better  still,  by  uniting  the  bands  with  solder  and  re-cementing 
them,  as  first  suggested  by  Professor  Guilford,  and  shown  in  Figs. 
1 1  and  89. 

Of  the  levers  shown  at  L,  Set  No.  i,  four  different  sizes  are 
furnished.  The  smallest  size  is  quite  strong  enough,  in  most  in- 
stances, for  double  rotation,  and  is  most  conmionly  used  by  me, 
especially  on  the  teeth  of  children. 

These  levers  are  plated  in  such  a  manner  as  to  nearly  overcome 
the  annoyance  of  oxidation  and  discoloration  of  the  teeth  in  their 
use,  thus  obviating  an  objection  to  the  employment  of  steel  wire 
in  the  construction  of  regulating  appliances. 

The  reader  should  never  confuse  the  wire  G,  Set  No.  i,  with 
these  levers.  Their  uses  are  as  different  as  the  material  of  which 
they  are  composed.  The  levers  are  used  only  in  rotation  (occa- 
sionally in  expansion),  and  are  never  united  by  solder  in  forming 
an  attachment;  while  the  wire  G,  Set  No.  i,  is  extremely  tough 
and  malleable  and  has  a  very  wide  range  of  application,  such  as 
reinforcing  anchorage,  retention,  making  spurs,  staples,  etc. 

Section  VH.     Elevation. 

The  elevation  of  a  tooth  in  its  socket  may  be  accomplished  as 
shown  in  Fig.  36,  wherein  a  superior  cuspid  is  being  drawn  out 
or  erupted  into  line.     The  clamp-band  No.  3,  Fig.  6,  was  fixed 

Fig.  36. 


on  the  lower  second  bicuspid.  A  very  small  hole  was  drilled 
into  the  cuspid,  and  a  short  pin  was  set  with  thin  cement.  A 
common  pin  answers  the  purpose  very  well,  and  the  hole  need 
not  be  deeper  than  the  enamel  if  the  pin  is  accurately  fitted  to 
it.     A   rubber   ligature   was   given   the   patient   with   instructions 


42  THE   ANGLE    SYSTEM. 

to  slip  it  over  the  pins,  as  shown  in  the  engraving.  The  anchor- 
tooth  in  this  case  is  directly  opposed  by  the  superior  bicuspid. 
The  anchorage  is  simple  and  efficient.  The  ligature  may  be 
worn  at  night  only,  so  as  to  interfere  as  little  as  possible  with 
speech  and  mastication,  although  some  patients  wear  it  almost 
continuously.  Too  strong  a  ligature  should  not  be  worn,  as  it 
might  endanger  the  life  of  the  pulp,  but  gentle  traction  should  be 
used,  gradually  directing  the  tooth  into  its  proper  position.  The 
direction  of  force  to  be  exerted  upon  the  tooth  to  be  moved  will 
of  course  indicate  which  tooth  in  the  inferior  arch  should  be 
selected  for  anchorage.  Should  the  anchorage  fall  upon  a  tooth 
with  no  antagonist  there  would,  of  course,  be  danger  of  loosen- 
ing it. 

Fig.  37  shows  a  case  in  which  the  anchorage  was  modified  tO' 
suit  the  conditions.     A  deciduous  cuspid  had  been  retained  too 

Fig.  zt. 


long,  causing  the  permanent  cuspid  to  remain  in  the  alveolar 
process  on  the  lingual  side  of  the  lateral  incisor,  necessitating  a 
complex  movement  of  the  tooth  backward,  outward,  and  down- 
ward, requiring  a  very  firm  anchorage  and  a  strong  ligature. 
On  the  inferior  cuspid  and  second  bicuspid  were  fixed  bands,, 
having  pipes  R,  Set  No.  i,  atached  to  their  labial  surfaces.  A 
piece  of  the  wire  G  of  suitable  length  was  bent  at  right  angles 
and  hooked  into  the  pipes,  as  shown.  The  wire  fits  the  bore  of 
the  pipe  so  accurately  that  in  cutting  off  the  ends  which  emerge 
through  them,  each  end  spreads  sufficiently  to  prevent  its  coming 
out.  A  pin  was  soldered  to  the  wire  about  midway  between  the 
pipes.  The  ligature  was  stretched  from  pin  to  pin,  as  seen  in  the 
engraving. 

Fig.  38  shows  a  modification  of  this  method  of  anchorage. 
The  anchor-wire  was  made  detachable  and  the  pin  dispensed  with, 
the  patient  slipping  the  wire  through  the  ligature  and  into  the 
pipes  upon  retiring,  and  removing  it  during  the  day.     A  delicate 


DIRECTION    OF    FORCES    FOR    TOOTH-MOVEMENT.  43 

band  (made  of  F,  Set  Xo.  i),  to  which  was  soldered  the  pin,  was 
fixed  on  the  moving  tooth. 

Fig.  39  ilkistrates  a  case  in  which  the  appHances  used  were 
similar  to  those  before  described,  but  the  wire  anchorage  was 
attached  to  teeth  in  the  same  arch  in  which  was  located  the 
malposed  tooth.  The  first  bicuspid  was  banded  and  a  pipe  R, 
Set  No.  I,  soldered  to  the  labial  surface  of  the  band,  in  which  was 

Fig.  38. 


hooked  a  piece  of  the  wire  G,  Set  No.  i,  the  other  end  of  the 
wire  being  bent  so  as  to  rest  on  the  cutting-edge  of  the  lateral 
incisor.  A  pin  was  soldered  to  this  wire,  as  in  the  case  before 
described,  and  a  rubber  ligature  stretched  from  pin  to  pin.  In 
some  cases  where  more  force  was  necessary,  I  have  used  the 
combined  anchorage  described. 

Fig.  39. 


^^Sf*""'  "^il 


A  tooth  may  also  be  elevated  in  its  socket  by  employing  either 
of  the  wire  arches  E  or  B  as  an  anchorage;  attaching  the  ligature 
to  the  tooth  to  be  moved  in  any  of  the  ways  already  described. 

Fig.  40  shows  the  application  of  a  modification  of  this  principle 
in  a  case  where  all  of  the  superior  incisors  are  being  elevated  by 
means  of  the  spring  of  the  wire  arch. ;(  The  arch  is  made  to  bear 
against  spurs  soldered  to  bands  upon  the  cuspids,  which  act  as  a 
fulcrum,  while  the  central  portion  of  the  arch  is  sprung  upward 


44 


THE    ANGLE    SYSTEM. 


and  hooked  over  spurs  soldered  to  bands  upon  the  centrals.  The 
arch  should  be  occasionally  removed  and  modified  by  bending,  in 
order  to  maintain  the  proper  amount  of  spring.  Either  of  the 
arches  (E  or  B)  may  be  used  for  this  purpose. 

Fig.  40. 


f-MA 


Section  VIII.     Expansion. 

There  are  several  methods  of  expanding  the  arch  by  this  system. 
First:  By  banding  and  tubing  the  first  and  last  teeth  of  those  to 
be  moved  on  each  side,  and  connecting  them  by  means  of  wire 
(G)  passing  through  the  tubes.  The  jack-screw  is  then  placed 
in  position  across  the  arch,  from  wire  to  wire.  Collars  R,  Set 
No.  I,  are  soft-soldered  to  the  wire  at  intervals  to  keep  the  screw 


Fig.  41. 


in  proper  position.  The  jack-screw  may  be  moved  forward  or 
backward,  according  to  the  varying  requirements  of  the  case. 
Before  placing  in  position,  the  wires  which  pass  along  the  sides 
of  the  arch  should  be  bent  to  correspond  to  the  shape  of  the 
sides  of  an  ideal  arch,  or  exactly  as  we  wish  the  teeth  to  be  when 
finally  arranged.  The  appliances  in  position  are  accurately  shown 
in  Fig.  41. 


DIRECTION    OF    FORCES    FOR   TOOTH-MOVEMENT. 


45 


Fig.  42  shows  a  modification  of  this  method  of  expansion,  the 
force  being  derived  from  one  of  the  levers  L,  Set  No.  i,  bent  in 
the  form  of  the  well-known  Coffin  spring,  affording  all  the  advan- 
tages of  the  Coffin  method  of  expansion,  without  the  disagreeable 
features  of  the  vulcanite  plate.  Its  chief  advantage  over  the  above 
method  is  that  it  may  be  also  used  in  expanding  the  lower  arch, 
without  interfering  with  the  movement  of  the  tongue,  as  would 
jack-screws. 

The  appliance  for  double  rotation  shown  upon  the  central 
incisors  has  already  been  described,  and  is  repeated  only  to  illus- 
trate how  it  may  be  used  with  advantage  while  the  arch  is  being 
expanded  laterally;  the  rubber  ligature  is  used  at  the  same  time 
to  retract  the  incisors. 

Fig.  42. 


The  extra  tubes,  soldered  at  right  angles  to  little  collars  slipped 
upon  the  bars  on  each  side  of  the  arch,  are  for  engaging  the 
expanding  spring,  should  it  be  found  necessary  to  transfer  the 
pressure  to  that  part  of  the  arch.  Should  it  be  found  necessary 
to  move  a  tooth  beyond  this  side  bar,  stretch  a  rubber  wedge 
between  the  tooth  and  bar,  as  shown  in  Fig.  86.  This  simple 
method  of  moving  a  tooth  beyond  the  limits  of  the  appliance 
will  be  found  valuable  in  connection  with  the  other  parts  of  the 
system. 

Another  method  of  expanding  the  arch  laterally,  as  well  as 
anteriorly,  is  by  means  of  the  appliances  shown  in  Fig.  43, 
wherein  the  notched  ends  of  the  jack-screw  engage  a  piece  of 
one  of  the  wire  levers  L,  Set  No.  i,  held  in  position  by  notches 
formed  in  the  united  ends  of  the  bands  upon  the  lateral  incisors. 
The  sheaths  of  the  screws  were  held  by  solder  to  anchor  clamp- 
bands  on   the  first   molars.     The   incisors  were  moved   forward 


46 


THE   ANGLE    SYSTEM. 


by  turning  the  nuts  upon  the  jack-screws,  while  the  arch  was 
being  expanded  laterally,  by  means  of  one  of  the  spring  levers 
L,  Set  No.  I,  the  ends  of  which  had  been  bent  sharply  at  right 
angles,  and  made  to  engage  the  delicate  holes  bored  into  the 
sides  of  the  sheaths  of  the  jack-screws,  all  as  clearly  shown  in 
the  engraving.     A  modification  of  this  plan  is  to  exert  pressure 

Fig.  43. 


laterally  by  means  of  a  third  jack-screw  instead  of  the  spring, 
this  screw  being  notched  at  each  end  and  made  to  rest  in  contact 
with  the  screws  upon  the  sides  of  the  arch,  anterior  to  their  nuts. 

Another  excellent  method  of  expanding  the  arch  is  by  means 
of  lacing  the  teeth  to  the  expansion-arch  E,  shown  in  Figs.  4  and 
68.     The  wire  ligatures  are  occasionally  tightened  by  twisting, 

Fig.  44. 


until  the  teeth  have  been  moved  outward  and  made  to  conform 
to  the  shape  of  the  wire  arch.  The  increasing  size  of  the  arch 
is  provided  for  by  adjusting  the  nuts  in  front  of  the  tubes  upon 
the  anchor-bands.  By  this  method,  one  or  both  of  the  lateral 
sides  of  the  arch  may  be  expanded,  or  the  anterior  part  of  the 
arch  alone  may, be  moved  forward,  in  which  case  the  teeth  are 


DIRECTION    OF    FORCES    FOR   TOOTH-MOVEMENT.  47 

laced  to  the  arch  and  moved  forward  collectively  by  turning  the 
nuts.     (See  Fig.  68.) 

In  expanding  the  lateral  halves  of  the  arch  by  this  method,  the 
wire  arch  should  be  straightened  sufficiently  to  give  all  possible 
spring,  which  in  most  instances  exerts  sufficient  force.  In  cases 
where  the  teeth  are  extremely  firm,  the  expansion-arch  may  be 
reinforced  by  the  spring  from  one  of  the  levers  L,  Set  No.  i, 
bent  to  conform  to  the  inside  of  the  arch,  and  made  to  press  upon 
the  anchor-bands  D.  The  ends  of  the  wire  are  held  in  position 
by  being  bent  at  right  angles,  and  slipped  into  pipes  R,  Set  No.  i, 
which  have  been  soldered  at  right  angles  to  tubes  C,  slipped  over 
the  ends  of  the  screw  upon  the  clamp-bands  D,  all  as  shown  in 
Fig.  44. 

Fig.  45- 


If  it  is  desirable  to  exert  pressure  only  upon  the  bicuspids,  the 
spring  of  L  alone  is  sufficient,  when  held  in  proper  position,  by 
securing  the  ends  in  either  of  the  following  ways:  By  resting  in 
one  of  the  pipes  R,  Set  No.  i,  soldered  to  the  clamp-band  (the 
end  of  the  pipe  being  closed  as  shown  on  the  left  of  Fig.  45),  the 
arch  being  bent  so  as  to  lie  in  contact  with  and  also  exert  pressure 
upon  the  first  bicuspid;  or  the  end  may  be  secured,  as  on  the 
right  of  Fig.  45,  by  being  bent  to  engage  one  of  the  pipes  R,  Set 
No.  I,  soldered  to  the  nut  upon  the  clamp-band,  the  end  of  the 
band-screw  resting  against  the  first  bicuspid.  The  nut  must  be 
removed  from  the  screw  while  soldering,  or  pieces  of  the  anchor- 
wire  G,  Set  No.  I,  may  be  soldered  to  the  clamp-bands  encircling 
the  second  bicuspids,  the  front  ends  in  contact  with  the  lingual 
surfaces  of  the  first  bicuspids.  To  these  wires  are  soldered  at 
right  angles  the  pipes  R,  which  engage  the  ends  of  the  spring, 
as  in  Fig.  46.  Or  the  same  attachments  to  the  clamp-bands  upon 
the  bicuspids  may  be  made  as  already  described  and  shown  in 
Fig.  44. 

If  it  is  desirable  to  exert  i)ressure  upon  one  tooth  only,  a  pipe 
should  be  soldered  to  the  band  over  the  tooth  to  be  moved;  in 
this  pipe  rests  the  end  of  the  spring.     Bend  the  spring  so  that 


48  THE   ANGLE    SYSTEM. 

all  the  force  will  be  exerted  upon  the  one  tooth  to  be  moved, 
while  two  or  even  more  teeth  as  anchorage  on  the  opposite  side 
of  the  arch  antagonize  this  force.     This  latter  plan  will  be  found 

Fig.  46. 


useful  in  moving  outward   or  inward  a  single   molar,   which  is 
sometimes  desirable  in  order  to  establish  perfect  occlusion. 


CHAPTER  VII. 

PRACTICAL  CASES. 


Section  I.  Having  completed  the  description  of  the  principal 
ways  of  constructing  and  adjusting  the  appliances  for  moving 
and  retaining  the  teeth,  some  practical  cases  are  appended  to 
familiarize  the  reader  with  this  system,  and  enable  him  to  more 
easily  comprehend  its  intelligent  employment.  Such  simple  cases 
as  are  found  in  early  childhood  will  be  first  cited.  There  is  prob- 
ably no  limit  as  to  the  time  at  which  the  treatment  of  dental 
irregularities  may  be  commenced.  Cases  treated  so  late  as  at 
sixty  years  of  age  have  been  reported;  but  I  am  more  and  more 
impressed  with  the  great  advantages  of  beginning  the  treatment 
early,  just  as  soon  as  the  appearance  of  irregularities  is  manifest 
and  the  teeth  have  emerged  from  the  gum  sufficiently  to  admit  of 
banding.  Then,  when  nature  is  putting  forth  her  best  effort, 
when  growth  and  repair  are  most  rapid,  and  the  surrounding  tis- 
sues most  yielding,  employ  simple,  delicate  appliances  to  gradually 
move  the  teeth  into  their  normal  positions.  Studiously  avoid 
needless  interference  in  those  cases  where  it  is  apparent  that  nature 
will,  unaided,  correct  the  deformity;  but  take  professional  pride 
in  encounters  with  the  interlocked,  twisted  and  overlapped,  or 
otherwise  malposed  teeth,  which  usually  become  worse  and  com- 
plicate the  condition  of  the  teeth  yet  to  be  erupted. 

There  is  an  impression  among  a  large  number  of  dentists  that 


PRACTICAL    CASES. 


49 


treatment  should  be  deferred  until  after  the  age  of  fifteen,  or 
thereabouts,  or  until  the  teeth  have  taken  their  positions  in  the 
arch;  but  this  impression  is  erroneous  and  fruitful  of  much  harm, 
for  by  that  time  cases  become  complex  and  often  exceedingly 
difficult  to  treat,  and  conditions  are  established  which  it  is  impos- 
sible to  wholly  overcome. 

With  proper  appliances  used  at  the  right  time,  a  few  days  will 
often  accomplish  what  might  otherwise  require  many  months  if 
left  until  the  whole  dental  apparatus  is  in  disorder.  The  dis- 
comfort and  annoyance  of  a  suitable  regulating  appliance  is  slight 
in  youth,  but  liable  to  increase  somewhat  wath  advancing  years; 
yet  at  no  time  of  life,  if  the  operation  be  skillfully  performed,  need 
there  be  more  than  inconvenience;  never  real  pain. 

Fig.  47. 


Fig.  47  shows  an  erupting  central  incisor  being  moved  out  of 
inlock.  The  tooth  was  banded  and  one  of  the  pipes  R,  Set  No.  i, 
soldered  to  the  mesio-lingual  angle  of  the  band;  one  end  of  a  piece 
of  the  wire  G,  of  suitable  length,  was  inserted  into  this  pipe,  and 
the  other  end  secured  in  a  pit  formed  in  the  enamel  of  the  second 
deciduous  molar.  Force  was  exerted  upon  the  tooth  to  be  moved 
by  occasionally  pinching  this  wire  with  the  regulating  pliers  H, 
Fig.  8  B,  two  or  three  pinches  being  enough  to  lengthen  the  wire 
sufficiently  to  move  the  tooth  as  far  as  it  should  be  at  one  sitting. 
The  force  of  the  wire  being  exerted  wholly  upon  the  mesio-angle 
of  the  tooth,  it  was  rotated  as  well  as  moved  out  of  inlock.  The 
occlusion  of  the  lower  incisors  retained  it  in  its  new  position. 

Of  course,  one  of  the  jack-screws,  instead  of  the  wire,  might 
have  been  eniplr>ycd,  but  the  force  exerted  by  stretching  the  wire 
is  so  simple,  and  the  mere  wire  so  compact  and  powerful,  that  it 


50 


THE    ANGLE    SYSTEM. 


is  now  employed,  especially  in  the  treatment  of  children's  teeth, 
whenever  possible. 

Fig.  48  illustrates  a  case  which  I  believe  to  be  so  common  that 
it  may  be  regarded  as  typical,  and  the  method  of  treatment  is  one 
which  may  be  generally  employed  in  this  class  of  cases.  Because 
of  lateral  pressure  the  superior  central  incisors  had  erupted  much 
anterior  to  their  natural  positions,  and  the  laterals  were  appearing 

Fig.  48. 


posterior  to  their  correct  positions  (this  condition  is  not  clearly 
shown  in  the  engraving);  while  the  lateral  pressure  from  the 
inferior  deciduous  cuspids  caused  the  central  incisors  to  erupt 
inside,  and  the  laterals  outside  of  the  line.  The  treatment  clearly 
indicated  was  to  exert  lateral  pressure  upon  the  inferior  cuspids, 
sufQciently  to  provide  space  for  the  erupting  incisors.  As  the 
lower  cuspids  were  gradually  forced  farther  apart  their  occlusion 


Fig 


with  the  superior  cuspids  caused  them  also  to  be  forced  farther 
apart,  thereby  providing  space  for  the  erupting  superior  incisors. 
No  attempt  was  made  to  straighten  the  incoming  teeth  other  than 
to  provide  space  for  their  proper  eruption. 

The  appliance  exerting  lateral  pressure  upon  the  inferior  cuspids 
is  shown  in  Fig.  49.  A  straight  piece  of  the  wire  G,  Set  No.  i, 
was  secured  by  springing  the  ends  into  pits  formed  in  the  enamel 


PRACTICAL    CASES. 


51 


on  the  lingual  surfaces.  Force  was  exerted  by  occasionally 
pinching  with  the  regulating  pliers  to  lengthen  the  wire  as  already 
described.  About  once  a  week  was  as  often  as  the  wire  was 
lengthened. 

Fig.  50  shows  another  case  in  which  a  modification  of  this  plan 
of  treatment  was  used.  Not  only  was  it  requisite  to  exert  lateral 
pressure  upon  the  inferior  cuspids  in  order  to  provide  space  for 
the  erupting  permanent  incisors,  but  also  to  apply  gentle  pressure 
to  the  laterals  which  were  erupting  far  inside  of  the  dental  arch. 
The  cuspids  were  banded  and  pipes  R,  Set  No.  i,  attached  to 
their  disto-labial  surfaces.  The  distal  ends  of  the  pipes  were  then 
closed  by  a  soldered  piece  of  band  material.  Into  the  other  ends 
of  these  pipes  was  slipped  a  piece  of  the  wire  G,  bent  to  conform 
to  the  curve  of  the  arch.  Force  was  exerted  by  pinching  the  wire 
with  the  regulating  pliers  H,  Fig.  8  B,  as  before  described.    Gentle 


Fig.  50. 


traction  upon  the  malposed  laterals  was  made  by  encircling  them 
and  the  regulating-wire  with  ligatures,  which  were  occasionally 
tightened  by  twisting.  The  occlusion  of  the  cuspids  with  the 
superior  cuspids,  as  in  the  case  last  described,  caused  the  expan- 
sion of  the  upper  arch.  I  believe  the  line  of  treatment  here  indi- 
cated, namely:  beginning  at  the  proper  period,  gently  expanding 
the  inferior  arch  and  perfectly  arranging  the  four  incisors,  will 
solve  the  problem  of  treatment  in  a  very  large  percentage  of  cases, 
the  upper  teeth  being  forced  to  develop  normally  by  the  occlusion 
with  the  moving  lower  teeth. 

In  pursuing  this  line  of  treatment,  the  expansion  of  the  lower 
arch  must  be  accomplished  very  gradually,  or  an  inlocking  of  the 
upper  teeth  will  be  the  result. 

Fig.  51  shows  the  expansion  of  the  anterior  part  of  the  inferior 
arch  by  the  same  method,  the  ends  of  the  wire  being  soldered 
directly  to  the  Ungual  surfaces  of  the  bands  encircling  the  cuspids. 
The  patient  was  a  young  lady,  twenty-two  years  of  age,  and  con- 


52 


THE    ANGLE    SYSTEM. 


siderable  force  was  necessary,  but  the  force  exerted  by  pinching 
the  wire  was  found  sufficient. 

The  centrals  were  drawn  into  the  Hne  of  arch  by  means  of  wire 
ligatures,  occasionally  tightened. 

A  little  experience  in  stretching  the  wire  with  the  regulating 
forceps  will  enable  the  operator  to  manipulate  the  wire,  by  bending 
as  well  as  pinching,  so  that  rotation  as  well  as  other  movements 
may  be  thus  accomplished. 

Fig.  si. 


Fig.  52  shows  how  an  ordinary  stay-plate  may  by  this  method 
be  modified  to  advantage  by  removing  a  portion  of  it  and  substi- 
tuting in  its  place  a  piece  of  the  wire  G,  Set  No.  i,  bent  and 
inserted  in  such  a  way  as  to  bring  pressure  upon  the  teeth  to  be 

Fig.  52. 


moved;  which  pressure  is  occasionally  intensified  by  pinching  the 
wire  with  the  stretcher. 

Fig.  53  represents  the  result  of  an  unnatural  contraction  of  the 
lips,  thus  bringing  undue  pressure  on  the  anterior  part  of  the  arch 
during  the  eruptive  period,  and  forcing  the  teeth  inward.  They 
were  pushed  outward  by  the  jack-screws  resting  over  spurs  upon 
the  anchor-bands,  the  chisel  ends  of  the  screw  resting  in  slots 


PRACTICAL    CASES. 


53 


formed  in  bands  on  the  moving  teeth.  (See  B,  Fig".  20,  and  C, 
Fig.  21.)  The  teeth  were  also  rotated  at  the  same  time  with  the 
rotating  levers  previously  described,  and  here  well  shown.  In 
this  instance  two  levers  were  used,  crossing  each  other  in  the 
center.  The  lever  on  the  left  was  anchored  by  latching  it  into  a 
hook  soldered  to  the  anchor-band  on  the  second  bicuspid.     The 

Fig.  53. 


other  lever  was  anchored  by  hooking  it  into  one  of  the  little  pipes 
R,  Set  Xo.  I,  soldered  at  right  angles  to  the  tube  on  the  band  of 
the  lateral  which  engages  the  other  lever,  A  better  way  would 
have  been  to  have  secured  this  end  of  the  lever  by  a  ligature 
around  the  end  of  the  other  lever,  but  it  is  here  shown  to  illustrate 
one  of  the  many  optional  ways  of  securing  the  end  of  the  lever. 

Fig.  54. 


It  will  be  .seen  that  the  central  incisors  also  need  rotating. 
This  could  have  been  easily  accomplished  by  the  double  rotation 
lever,  but  the  same  practical  result  was  attained  by  lacing  them 
to  the  levers  with  wire  ligatures.  They  were  retained  by  bands 
united  with  solder.  (See  Fig,  54,)  This  is  an  excellent  method 
of   retention,   and   was   first    suggested   by    Dr.    Guilford.      They 


54 


THE    ANGLE    SYSTEM. 


could  have  been  retained  by  my  own  method,  namely,  by  passing 
a  piece  of  retaining-wire  G  through  the  horizontal  pipes  which 
had  secured  the  ends  of  the  levers,  and  lacing  the  centrals  to  it; 
but,  although  a  simple  and  effective  device,  it  would  have  been  a 
little  less  sightly. 

Fig.  55  shows  a  form  of  irregularity  frequently  met  with.  The 
arch  is  narrow,  and  the  lateral  incisors  are  being  rapidly  forced 
inward  by  the  erupting  cuspids.  In  a  very  few  months,  without 
treatment,  the  lateral  incisors  would  be  forced  far  inward,  and 
even  the  apices  of  the  roots  would  be  malposed;  therefore,  the 
earlier  regulation  is  begun  the  better. 

The  proper  treatment  is  the  expansion  of  the  arch  in  the  region 
of  the  bicuspids,  and  the  moving  of  the  centrals  forward  and  the 

Fig.  55- 


laterals  outward.  In  the  case  illustrated  this  was  accomplished 
by  the  jack-screws  engaging  at  their  notched  ends  a  piece  of  one 
of  the  levers  L,  Set  No.  i,  made  to  rest  in  notches  formed  in  the 
united  ends  of  the  bands  encircling  the  lateral  incisors.  Anchor- 
age for  the  jack-screws  was  gained  by  soldering  the  sides  of  the 
sheaths  to  the  anchor-clamp  for  the  first  molars  (as  in  F,  Fig.  20), 
while  the  lateral  sides  of  the  arch  were  forced  outward  by  means 
of  a  piece  of  one  of  the  spring  levers  L,  Set  No.  i,  the  ends  of 
which  were  bent  sharply  at  right  angles  and  made  to  engage 
small  holes  drilled  through  the  sheaths  of  the  jack-screws.  Wire 
ligatures  were  made  to  encircle  the  central  incisors  and  the  spring 
lever  engaged  by  the  notched  points  of  the  jack-screws.  All  as 
clearly  shown  in  the  engraving.  The  extra  holes  represented  in 
the  sheaths  were  for  shifting  the  expansion  spring,  should  it  be 
found  necessary. 

After  the  teeth  had  been  moved  into  their  desired  positions,  the 
bicuspids  were  held  outward  by  a  delicate-fitting  stay-plate,  similar 
to  Fig.  52,  while  the  incisors  were  retained  by  means  of  a  piece 


PRACTICAL    CASES. 


55 


of  the  wire  G,  Set  No.  i,  connecting  the  bands  upon  the  lateral 
incisors,  the  ends  being  soldered  to  the  labial  surfaces  of  the  bands 
and  the  intervening  portion  of  wire  lying  in  contact  with  the  labial 
surfaces  of  the  central  incisors.  These  retainers  were  worn  until 
the  cuspids  were  fully  erupted  and  all  the  teeth  had  become  firm 
in  their  new  positions. 

I  should  add,  this  patient  originally  suffered  from  greatly 
enlarged  tonsils. 

Fig.  56  shows  a  case  such  as  is  frequently  encountered  in  some 
of  its  modifications.  The  inlocked  cuspid  has  forced  the  lateral 
outward.  It  will  be  seen  by  studying  the  appliance  that  it  served 
the  double  purpose  of  pushing  outward  the  cuspid,  while  pulling 
inward  the  lateral;  the  sheath  of  the  jack-screw  being  cut  short, 
allowing  it  to  travel  downward  over  the  spur  as  the  nut  is  turned. 

Fig.  ;6. 


until  its  base  finally  rests  against  the  band,  when  the  lateral  will 
have  been  drawn  into  place,  and  will  reinforce  the  anchor-tooth 
in  resisting  the  moving  cuspid.  This  is  another  instance  of  recip- 
rocal anchorage,  or  that  of  pitting  one  irregular  tooth  against 
another.  It  is  a  principle  of  great  value,  and  should  be  carefully 
studied  and  made  use  of  whenever  possible.  The  extra  pipe  on 
the  sheath  of  the  jack-screw  was  for  further  reinforcing  the  anchor- 
age, if  necessary,  by  hooking  another  piece  of  the  wire  G  into  the 
pipe,  and  fixing  the  other  end  on  a  band  upon  the  first  bicuspid. 
Reciprocal  anchorage  may  be  gained  by  substituting  for  the  wire 
attached  to  the  lateral  the  small  traction-screw  C  and  B,  Fig.  i. 
Set  No.  I.  They  were  retained  by  uniting  their  bands  with  solder 
and  recementing  them  on  the  teeth. 

Fig.  57  shows  a  typical  case  and  the  combined  appliances 
actually  used.  The  laterals  were  inlocked,  the  left  cuspid  pushed 
forward.     While  the  large  traction-srrow  was  rlrawing  back  the 


56  THE    ANGLE    SYSTEM. 

cuspid,  as  already  described  on  page  28,  it  was  assisted  by  the 
loop  and  small  traction-screw  (see  Fig.  26),  acting  at  the  same 
time  in  forcing  outward  the  left  lateral;  another  instance  of  recip- 
rocal anchorage. 

The  other  lateral  was,  at  the  same  time,  forced  outward  by  the 


Fig 


jack-screw,  the  base  of  which  was  slipped  over  a  spur  soldered  to 
the  sheath  of  the  large  traction-screw,  again  making  use  of  recip- 
rocal anchorage  by  assisting  the  traction-screw  in  resistance  to 
the  cuspid.  The  anchorage  of  the  jack-screw  might  be  reinforced, 
as  already  described  in  Fig.  24.  Other  modifications  of  this 
combination  will  readily  suggest  themselves. 


Fig.  58  represents  a  common  form  of  irregularity.  All  of  the 
incisors  are  pressed  inward,  not  enough  to  cause  inlocking  of  the 
same,  but  sufficient  to  necessitate  the  closure  of  the  lower  jaw 
posterior  to  the  normal  occlusion,  in  some  instances  causing 
jumping  of  the  bite.  As  a  result,  there  is  not  sufficient  room  for 
the  cuspids,  and  in  the  effort  to  take  their  natural  positions  (a 


PRACTICAL    CASES. 


57 


tendency  always  strong  with  them),  the  laterals  are  forced  still 
farther  inward,  as  well  as  partially  rotated.  The  aim  will  be  to 
force  forward  all  the  incisors,  making  correct  occlusion,  as  well 
as  providing  space  for  the  cuspids.  The  rotating  levers  are 
applied  to  the  laterals,  and  the  centrals  firmly  laced  to  the  same, 
while  all  are  being  forced  forward  by  the  jack-screws  soldered 
to  the  anchor-bands  (see  F,  Fig.  20),  the  chisel-ends  resting  in 
staples  (as  in  E,  Fig.  21),  soldered  to  the  bands  on  the  laterals 
to  also  permit  their  rotation.  The  cuspids  were  brought  dow'n- 
ward  by  the  methods  shown  in  Fig.  36  or  Fig.  39. 

Fig.  59  represents  the  case  of  a  little  girl,  eight  and  one-half 
years  of  age.  The  centrals  were  inlocked,  the  left  one  being  also 
greatly  twisted.  As  soon  as  they  had  sufficiently  emerged  from 
the  gums  they  weie  banded.     The  union  of  the  ends  of  the  bands 

Fig.  59. 


was  made  at  the  disto-lingual  angle.  Small  holes  were  made  in 
these  united  ends,  through  which  was  slipped  a  piece  of  one  of 
the  small  levers  L,  Set  No.  i.  The  notched  ends  of  the  jack- 
screws  engaged  this  wire  lever.  The  base  of  the  sheaths  was 
secured  by  being  slipped  over  the  ends  of  the  clamp-band  screws. 
(See  J,  Fig.  20.)  Rotation  of  the  central  was  accomplished  at  the 
same  time  the  teeth  were  being  moved  out,  by  occasionally 
tightening  a  wire  ligature  surrounding  the  spring  wire  and  a  spur 
soldered  to  the  labial  surface  of  the  band.  After  the  teeth  had 
been  moved  in  the  desired  position,  they  were  retained  by  the 
ai)pliances  for  a  few  days,  until  all  tenderness  had  subsided,  when 
the  bands  upon  the  centrals  were  united  by  solder,  re-cemented, 
and  the  rest  of  the  apparatus  dispensed  with.  The  occlusion  of 
the  lower  teeth  is  usually  sufficient  to  retain  such  teeth  as  have 
been  moved  out  of  inlock,  after  they  have  been  steadied  in  their 
new  position  U>r  a  few  days  by  an  ai)j)liancc.     T>ut  in  this  case 


58 


THE    ANGLE    SYSTEM. 


the  retaining  bands  were  worn  until  the  lateral  incisors  had  fully 
erupted,  in  order  to  prevent  the  possibility  of  their  again  over- 
lapping. 

Fig.  60  shows  a  malposed  lateral  and  central.  The  base  of  the 
jack-screw  was  soldered  to  a  band  on  the  opposite  cuspid,  and 
reinforced  by  a  spur  resting  against  the  first  bicuspid,  as  also  by 
the  large  traction-screw,  which  is  hooked  into  a  tube,  D,  Set  No.  i, 
soldered  to  the  labial  surface  of  the  band.  The  screw  passes  in 
front  of  the  incisors  through  a  tube  (against  which  the  nut  works) 
soldered  to  a  band  on  the  labial  surface  of  the  lateral  incisor.  In 
this  case  the  left  central  and  lateral  were  wedged  forward  in  the 

Fig.  60. 


line  of  arch,  closing  the  space  between  the  centrals  and,  at  the  same 
time,  providing  space  for  the  outmoving  cuspid.  The  large  screw 
was  beaten  flat  and  polished  before  insertion. 

I  have  sometimes  closed  similar  spaces  between  the  incisors 
by  the  appliance  shown  in  Fig.  61,  which  consists  of  tubes,  C, 
Set  No.  I,  soldered  to  the  ends  of  a  piece  of  the  band  material 
long  enough  to  nearly  inclose  the  four  incisors.  The  small 
traction-screw  B  is  inserted  in  the  tubes,  and  the  space  contracted 
by  turning  the  nut. 

Fig.  61. 


Figs.  62,  63,  and  64  show  other  simple  and  convenient  ways 
of  moving  a  tooth  into  line.  In  Fig.  62  the  anchorage  for  the 
ligature  is  a  sheath  of  the  jack-screw  J,  Fig.  20,  slipped  over  the 
end  of  the  screw  upon  the  molar  clamp-band.  Force  is  exerted 
by  occasionally  tightening  the  wire  ligature  around  the  sheath  and 


PRACTICAL    CASES. 


59 


tooth  to  be  moved.  In  some  instances  the  sheath  may  be  dis- 
pensed with,  as  in  Fig.  63.  Another  modification  is  shown  in 
Fig.  64,  which  consists  of  a  pipe  (R,  Set  No.  i)  soldered  perpen- 
dicularly to  the  side  of  the  clamp-band,  into  which  is  hooked  a 
piece  of  the  wire  G,  Set  No.  i,  which  rests  against  some  suitable 


Fig.  62. 


"v       K*^  h^^  yU-^  \- 


FlG.   63. 


Fig.  64. 


tooth,  to  assist  the  anchor-tooth ;  the  anchor-wire  and  the  tooth 
to  be  moved  being  encircled  by  a  wire  or  rubber  ligature. 

Fig,  65  is  a  side  view  of  a  very  marked  case  of  irregularities 
of  the  teeth  of  both  arches,  the  patient  being  a  young  lady  of 
sixteen  years.  The  superior  arch  was  much  compressed  in  front, 
the  incisors  greatly  twisted  and  overlapping,  and  the  cuspids  very 


Fig.  6= 


prominent,  as  shown  in  Fig.  66.  The  first  molars  and  bicuspids 
were  also  more  or  less  malposcd,  while  the  inferior  arch  was  much 
contracted,  and  all  the  lecth  anterior  to  the  first  molars  were  very 
irregular.  The  treatment  consisted  in  establishing  correct  occlu- 
sion by  forcing  the  malpr)sed  teeth  into  their  correct  positions  in 
the  arches.  This  was  accomplished  in  the  lower  jaw  by  means  of 
the  expansion-arch  F,  anchor-tube  and  clamp-band  D,  wire  liga- 


6o 


THE   ANGLE    SYSTEM. 


tures  and  bands,  as  shown  in  Fig.  67;  also  shown  in  position  in 
Fig.  68.  The  bicuspids  were  moved  outward  by  wire  ligatures 
occasionally  tightened  by  twisting,  while  at  the  same  time  and 


Fig.  66. 


Fig.  67. 


by  the  same  means  the  incisors  were  being  drawn  into  proper 
positions,  and  made  to  conform  to  the  shape  of  the  wire  arch 
passing  in  front  of  them.  They  were  also  moved  forward  at  the 
same  time  by  the  tightening  of  the  nuts  in  front  of  the  anchor- 


PRACTICAL    CASES. 


6l 


tubes  upon  the  molars,  thus  providing  more  space  for  the  bicuspids 
as  they  were  forced  outward.  The  cuspid  was  rotated  with  a  wire 
Hgature,  attached  to  a  spur  upon  the  disto-Hngual  angle  of  the 
band,  while  force  was  being  exerted  in  an  opposite  direction  upon 
the  mesio-labial  angle  of  the  tooth,  by  a  rubber  wedge  stretched 
between  the  tooth  and  the  wire  arch,  all  as  correctly  shown  in  the 
engraving. 

Fig.  69  shows  the  case  nearing  completion.     After  the  move- 

FiG.  69. 


nient  of  the  teeth  had  been  completed  they  were  retained  for  about 
two  weeks,  until  all  tenderness  had  subsided,  by  the  appliance 
already  in  position  and  shown  in  Fig.  69.  The  appliance  was 
then  removed  and  the  teeth  permanently  retained  as  seen  in  Fig. 
70.  The  cuspids  were  carefully  banded,  and  the  ends  of  a  piece 
of  the  wire  G,  Set  No.  t,  were  soldered  to  the  lingual  surfaces  of 
the  bands,  the  wire  resting  in  contact  with  the  lingual  surfaces  of 
the  incisors,  and  preventing  their  again  moving  inward,  as  also 
resisting  lateral  pressure  from  the  cuspids.     The  bicuspids  were 


62 


THE    ANGLE    SYSTEM. 


prevented  from  moving  inward  by  pieces  of  the  wire  G,  resting  on 
the  Ungual  surfaces  and  held  in  position  by  their  anterior  ends 
inserted  into  pipes  (R)  soldered  to  the  disto-lingual  surfaces  of 
the  bands.  The  distal  ends  of  the  wires  were  made  to  rest  in  small 
cavities  formed  in  the  mesial  surfaces  of  the  first  molars,  one  of 
which  had  long  been  covered  by  a  gold  crown. 

The  teeth  in  the  upper  arch  were  forced  into  their  correct 
positions  by  an  appliance  similar  to  that  shown  in  the  treatment 
of  the  lower  arch  already  described.  The  incisors  were  moved 
forward  and  rotated  by  means  of  the  ligatures  and  tightening  of 
the  nuts  in  front  of  the  anchor-tubes,  while  pressure  was  exerted 
upon  the  prominent  cuspids  and  bicuspids  by  the  spring  of  the 
wire  arch  intensified  by  intervening  wedges  of  rubber.     The  first 

Fig.  71. 


molars  were  rotated  at  the  same  time  by  the  tubes  upon  the 
anchor-bands  being  so  adjusted  that  rotating  force  was  exerted 
by  the  spring  of  the  wire  arch.  After  the  teeth  had  been  moved 
they  were  retained  in  the  way  described  for  the  retention  of  the 
teeth  in  the  lower  arch,  with  the  exception  that  one  continuous 
piece  of  the  wire  was  used,  accurately  shown  in  Fig.  71. 

This  method  of  retention  is  useful  in  all  cases  of  this  class. 
Considerable  accuracy  is  necessary  in  the  adjustment  of  the  band, 
wire,  etc.;  however,  if,  after  adjustment,  it  is  found  shorter  than 
it  should  be,  it  is  easily  lengthened  by  a  few  pinches  with  the  wire- 
stretchers  H,  Fig.  8  B;  if  found  slightly  longer  than  necessary,  it 
is  easily  shortened  by  bending  it  to  conform  to  the  circles  of  the 
teeth  by  means  of  a  burnisher  pressed  against  the  wire  in  the 
region  of  the  interdental  spaces.  If,  after  a  time,  it  is  found  that 
one  of  the  intervening  teeth  shall  have  moved  slightly  inward,  it 


PRACTICAL    CASES.  03 

should  be  again  moved  outward  by  a  wedge  of  rubber  stretched 
between  retaining-wire  and  tooth  for  a  few  days.  The  wedge  is 
then  removed,  and  the  soft  wire  burnished  or  driven  outward  in 
contact  with  the  readjusted  teeth.  The  distal  ends  of  the  retain- 
ing-wire should  always  be  set  in  cement,  and  the  pits  should  be 
carefully  tilled  after  the  removal  of  the  retainer.  The  retainers 
in  the  case  here  shown  were  worn  for  one  year.  They  were  so 
compact  and  cleanly  that  the  patient  was  in  nowise  incon- 
venienced, and  the  improvement  in  her  appearance  after  the  treat- 
ment can  be  better  imagined  than  described. 

Section  II.     Jumping  the  Bite. 

Fig.  72  truthfully  represents  the  side  view  of  a  case  of  increasing 
prominence  of  the  anterior  upper  teeth,  the  cause  of  which  I  believe 
was  clearly  traceable  to  the  premature  loss  of  the  inferior  first 
molars.     The  occlusion  of  the  second   inferior  molars  with  the 

Fig.  'J2. 


superior  first  permanent  molars  is  well  shown  in  the  cut;  and  as 
this  occlusion  naturally  continued  with  the  inevitable  tipping 
forward  of  the  inferior  second  molar  into  the  space  vacated  by  the 
first  molar,  the  lower  jaw  was  gradually  drawn  backward  until  the 
jumping  of  the  bite  of  the  developing  cuspids  and  bicuspids  had 
taken  place.  At  the  same  time  the  compression  of  the  lateral 
halves  of  the  superior  arch,  in  order  to  better  conform  to  the  de- 
(-reasing  size  (by  recession)  of  the  lower  arch  naturally  followed, 
pioducing,  as  is  here  well  shown,  the  condition  which  is  similar  to 
thousands  of  cases  resulting  from  the  extraction  of  the  inferior 
first  molars  by  ignorant  or  unscrupulous  practitioners. 

The  treatment  consisted  in  widening  the  upper  arch  suf^cicntly 
to  permit  of  the  lower  jaw  being  moved  forward,  and  there  retained 
until  the  habit  of  normal  occlusion  had  been  re-established.  The 
arch  was  expanded  by  means  of  the  wire  arch  B  (expansion-arch 
R  would  have  answered),  and  anchor  clamp-bands  D,  as  shown  in 


64 


THE   ANGLE    SYSTEM. 


Set  No.  2.  The  centrals  and  laterals  were  moved  outward,  and 
rotated  by  occasionally  tig-htening  wire  ligatures  encircling  the 
arch  and  spurs  soldered  to  bands  upon  the  moving  teeth.  All  as 
clearly  shown  in  Fig.  73. 

Fig".  74  correctly  represents  the  case  as  seen  after  the  expansion 
of  the  arch  was  completed,  the  deciduous  second  molars  having  in 
the  mean  time  been  lost,  but  not  yet  replaced  by  the  bicuspids. 


Fig.  75  shows  the  lower  jaw  moved  forward  to  its  correct  posi- 
tion, where  it  was  retained  by  means  of  a  spur  imbedded  in  the 
inferior  permanent  molar,  thus  compelling  the  normal  closure  of 
the  jaw.     The  retention  of  the  upper  anterior  teeth  was  accom- 


FiG.  74. 


plished  wholly  by  the  proper  occlusion  with  the  lower.  The  spur 
has  now  been  worn  six  months,  and,  I  believe,  might  be  discon- 
tinued without  fear  of  recession  of  the  jaw;  but,  as  it  occasions 
no  inconvenience,  it  will  be  worn  for  a  few  months  longer,  or  until 
the  eruption  of  the  second  superior  bicuspid  shall  necessitate  its 
being  gradually  shortened  by  grinding. 

It  seems  to  me  that  jumping  the  bite  is  not  difficult  of  accom- 


PRACTICAL    CASES. 


65 


plishment,  and  is  a  most  natural  and  advisable  plan  of  treatment 
where  the  age  of  the  patient  and  other  conditions  are  proper. 

Fig.  76  shows  another  case  of  very  marked  irregularity,  where 
both  centrals  and  laterals  and  right  cuspids  were  greatly  turned; 
they  were  also  pushed  forward,  as  shown  in  Fig.  jy. 

Fig.' 75- 


Fig.  78  shows  the  appliances  as  adjusted  at  the  commencement 
of  the  treatment.  It  will  be  seen  that  the  cuspids  are  being  moved 
backward  into  the  spaces  from  which  the  first  bicuspids  have  been 
extracted,  by  means  of  the  large  traction-screws  (A  and  D,  Set 
No.  i),  adjusted  and  operated  as  described  on  page  28.     It  will 


also  be  noticed  that  the  angle  of  the  traction-screw  on  the  right 
is  hooked  over  a  spur,  or,  bettor,  a  staple  made  from  wire  G,  Set 
No.  I,  soldered  at  right  angles  to  the  band,  thus  concentrating  all 
the  force  on  one  sifle  of  the  tooth  as  it  moved  l^ackward. 

The  central  incisors  are  being  rotated  by  means  of  the  lever, 
as  described  in  Fig.  34.  Their  i)rominence  was  also  reduced  at  the 
same  time  by  means  of  the  occipital  bandage  and  traction-l)ar,  as 
described  on  page  40. 


66 


THE   ANGLE    SYSTEM. 


Fig.  79  exhibits  the  case  after  being  acted  upon  by  the  appli- 
ances already  described.  They  were  retained  by  uniting  with 
solder  the  bands  and  re-cementing  them  upon  the  centrals,  while 

Fig.  ^^. 


Fig    78 


the  traction-screws  retained  the  cuspids.  The  rotation  of  the 
lateral  incisors  was  accomplished  with  the  rotating  levers  in  the 
usual  way,  securing  the  ends  of  the  levers  by  ligatures  attached 
to  the  distal  ends  of  the  traction-screws.     After  they  were  rotated, 


PRACTICAL    CASES. 


67 


the  bands  were  removed,  united  with  solder  to  the  bands  upon 
the  centrals,  and  all  reset  on  the  teeth  with  cement.  The  traction- 
screws  and  bands  upon  the  cuspids  were  removed,  and  the  case 
then  presented  the  appearance  shown  in  Fig.  80.  The  retaining- 
bands  were  worn  one  year,  after  which  the  teeth  showed  no 
tendency  to  return  to  their  former  positions. 

Fig.  80. 


Section  III.      Excessive  I'rotrusiqx  of  the  Upper  Teeth. 

Fig.  81  represents  a  typical  case  of  a  very  marked  class  of  dental 
irregularities,  quite  common  and  always  unsightly.  The  principal 
characteristic  is  the  excessive  prominence  of  the  superior  incisors, 
laterals,  and  cuspids.  The  upper  lip  is  always  short,  probably  due 
to  lack  of  development  from  being  held  in  an  abnormal  position, 
and  through  inability  to  close  the  lips  over  the  prominent  teeth. 

Fig.  81. 


The  lower  jaw  is  generally  short,  and  the  occlusion  of  the  molars 
and  bicuspids  is  usually  g(Kjd,  although  posterior  to  the  normal. 
As  a  result  the  lateral  halves  of  the  superior  arch  are  commonly 
closer  than  normal,  so  as  to  be  better  acconmiodated  to  the 
smaller  circle  of  the  lower  arch.  The  lower  incisors  are  more  or 
less  irregular,  and  tluir  cutting-edges  always  occupy  a  higher 
l)lane  than  normal,  doubtless  owing  to  the  lack  of  working  occlu- 
sion. As  a  result  of  the  fre(|ucnt  attem])ts  at  complete  closure  of 
the  month,  the  lower  lip  is  forced  between   the  U[)|)er  and   lower 


68 


THE   ANGLE    SYSTEM. 


incisors,  and  exerts  pressure  outward  upon  the  superior  and 
inward  upon  the  lower  incisors,  which  intensifies  the  malpositions 
of  both.  This  form  of  irregularities  is  usually  associated  with 
conditions  of  the  nasal  passage  which  necessitate  mouth-breathing. 
Fig.  82  represents  a  side  view  of  a  case  of  a  child  eight  years 
old,  whose  nasal  passage  was  obstructed  for  three  or  four  years, 
necessitating  mouth-breathing.  The  superior  centrals  had  erupted 
much  anterior  to  their  proper  positions,  their  labial  surfaces  nearly 
at  right  angles,  while  the  laterals  had  not  yet  erupted.  The 
deciduous  cuspids  and  molars  were  in  position,  as  well  as  the  first 
permanent  molars.  As  the  mouth  was  held  open  so  much  of  the 
time,  the  lower  jaw  was  either  gradually  forced  back  from  its 
normal  occlusion  or  prevented  from  developing,  while  the  upper 
arch  contracted  laterally,  in  order  to  better  accommodate  the 
occlusion  to  the  smaller  circle  of  the  retreating  lower  arch.     The 

Fig.  82. 


development  of  the  upper  lip  seemed  to  have  been  arrested,  and 
had  but  little  restraining  influence  upon  the  upper  incisors,  which 
were  being  acted  upon  unfavorably  by  the  forcing  of  the  lower  lip 
between  the  upper  and  lower  incisors,  in  the  frequent  attempts  at 
swallowing.  This  pressure  of  the  lip  had  also  exerted  an  influence 
upon  the  lower  incisors.  They  were  becoming  bunched  and 
forced  inward,  thereby  allowing  more  space  for  the  lip  to  occupy 
between  the  upper  and  lower  incisors.  The  conditions  then  were 
favorable  for  the  development  of  excessive  protrusion  of  the  upper 
anterior  teeth  and  all  the  accompanying  deformities  already  de- 
scribed in  the  case  of  the  adult. 

The  plan  of  treatment  of  these  cases  should  vary  according  to 
the  age  of  the  patient.  In  the  present  instance  the  child  was  first 
referred  to  the  rhinologist  for  treatment  of  the  nasal  passages. 
He  having  been  successful,  efforts  were  then  directed  to  the 
restoring  of  the  normal  occlusion  of  the  teeth. 

The  central  incisors  were  rotated  after  the  manner  described 
in  double  rotation.     The  lower  incisors  were  made  to  occupy  their 


PRACTICAL    CASES.  69 

correct  positions  in  the  arch,  after  plan  shown  in  Fig.  51,  and  were 
also  slightly  shortened  by  grinding.  The  upper  arch  was  ex- 
panded laterally  to  permit  the  movement  of  the  lower  jaw  forward 
so  that  the  teeth  might  occlude  normally,  as  shown  in  Fig.  83. 
Breathing  through  the  nose  was  encouraged,  and  the  patient 
directed  to  keep  the  lips  closed  and  teeth  in  proper  occlusion  as 
much  of  the  time  as  possible,  and  I  had  the  satisfaction  of  seeing 
the  habit  of  normal  occlusion,  as  well  as  normal  brealhing,  re- 
established. 

In  the  treatment  of  cases  fully  developed,  it  would  be  useless  to 
attempt  to  restore  normal  occlusion,  as  in  the  case  last  described 
— viz,  widening  the  upper  arch  and  moving  the  lower  jaw  forward. 
The  general  plan  of  treatment,  then,  is  as  follows:  First,  to  com- 
press the  superior  incisors  in  their  sockets.     Second,  to  reduce  the 


Fig.  83. 


size  of  the  superior  arch  by  extracting  one  or  both  of  the  first 
bicuspids,  and  move  the  incisors  and  cuspids  backward.  Third, 
to  correct  the  malpositions  of  the  inferior  incisors  and  cuspids, 
and  reduce  their  length  by  grinding.  Fourth,  to  establish  normal 
breathing  and  normal  closure  of  the  lips.  For  accomplishing  this 
the  Set  No.  2  (see  Figs.  2  and  3)  was  especially  designed,  and 
comes  the  nearest  to  the  ideal  of  all  appliances  yet  devised. 

The  anchor-bands  and  tubes  D  are  made  to  encircle  the  first 
molars.  The  ends  of  the  wire  arch  B  are  slipped  through  the 
tubes.  The  anterior  part  of  the  arch  is  held  in  position  by  bands 
on  the  central  incisors,  having  notches  formed  in  the  united  ends 
upon  the  mesio-labial  surfaces,  into  which  the  arch  rests,  as  shown 
in  Fig.  84. 

Force  is  exerted  upon  this  wire  arch  by  heavy  elastic  bands 
attached  to  the  head-gear,  as  in  Fig.  85.  This  force  is  received 
and  transmitted  to  the  wire  arch  by  means  of  the  traction-bar  A, 
Set  No.  2,  the  standard  seen  upon  the  center  of  the  traction-bar 
engaging  the  delicate  ball  upon  the  center  of  the  wire  arch.  The 
hooks  upon  the  ends  of  the  traction-bar  receive  the  ends  of  the 
elastics.     Any  degree  of  force  may  be  exerted  upon  tlie  prominent 


70 


THE    AXGLE    SYSTEM. 


teeth  by  increasing  or  diminishing  the  tension  or  size  of  the 
elastics.  The  force  received  from  the  head-gear  acts  on  the  wire 
arch  through  the  bah-and-socket  joint.  The  ends  of  the  traction- 
bar  may,  therefore,  be  casuahy  moved  in  any  direction.  The 
advantage  is  that  in  consequence  of  the  freedom  of  motion,  a  jar 
or  shock  upon  the  traction-bar  ends  will  not  be  transmitted  to  the 
tender  teeth.  As  the  bandage  and  bar  are  to  be  worn  at  night, 
contact  with  the  pillow  would  be  liable  to  occasion  pain  were  it 
not  for  this  freedom  of  movement,  an  advantage  possessed  by  no 
other  device  of  its  class  and  appreciable  by  both  patient  and 
operator.  The  usual  method  is  to  rigidly  attach  the  traction-bar, 
or  its  equivalent,  to  a  swaged  or  vulcanite  cap  covering  and  firmly 
resting-  aeainst  all  the  teeth  to  be  moved. 


Fig.  84. 


At  such  times  as  the  head-gear  and  elastics  are  not  worn, 
provision  is  made  for  holding  what  has  been  gained  by  delicate 
rubber  ligatures  E,  E,  Set  No.  2,  which  are  slipped  over  the  distal 
ends  of  the  tubes  on  the  molars,  stretched  forward,  and  tied  with 
silk  ligatures  in  front  of  the  small  collars  which  encircle  the  wire 
arch  opposite  the  cuspids,  as  seen  in  Fig.  84. 

These  collars,  being  rigid,  prevent  the  ligatures  from  sliding 
back,  and  thus  exert  a  gentle  but  constant  traction  on  the  moving 
teeth,  and  prevent  them  from  springing  back  and  interfering  with 
the  process  of  repair.  Of  course,  these  ligatures  are  worn  con- 
stantly. Another  advantage  of  the  device  is,  that  not  only  is  the 
prominence  of  the  teeth  reduced,  but  the  malposed  teeth  are  grad- 
ually forced  to  take  regular  positions  and  conform  to  the  shape 
of  the  ideal  arch  (as  it  is  forced  backward  through  the  tubes  on 


J'KACTICAL    CASliS. 


7^ 


the  molarsj,  an  actioti  iniixjssiljlc  with  devices  havinj,'-  fixed  caps 
of  vulcanite  or  gold.  Still  another  advantage  is,  that  if  the  arch 
should  need  lateral  expansion,  as  is  frequently  the  case,  it  may 
be  accomplished  at  the  same  time  the  teeth  are  being  moved  back- 
ward, by  lacing  to  the  wire  arch  such  teeth  as  need  to  be  moved 
outward.  But  in  obstinate  cases  the  jack-screw,  notched  at  each 
end  and  resting  in  contact  with  pieces  of  the  G  wire,  may  be 
employed,  as  clearly  shown  in  Fig.  86,  wherein  two  rubber  wedges, 
shown  resting  between  the  bicuspids  and  wire,  were  used  to  move 
them  farther  outward  than  was  possible  with  the  straight  wire. 
The  head-gear  projjcr  has  l)een  greatly  inijjroved,  as  a  result  of 

Fin.  85. 


much  experimenting,  and  is  correctly  shown  in  Fig.  85.  It  con- 
sists of  a  non-collapsible  sjjring  rim,  adjustable  as  to  size  by  the 
spring  latch  on  the  side.  The  netting  covering  the  head  is  ad- 
justed by  tightening  or  loosening  the  silk  cord  connecting  the  rim 
with  the  heavy  silk  netting,  which  provides  for  thorough  venti- 
lation. One  great  advantage  of  this  head-gear  is,  that  the  rim 
receives  the  force  and  distributes  it  equally  over  the  entire  back 
of  the  head,  so  that  much  greater  pressure  can  be  borne  without 
causing  headache,  a  comnif>n  result  of  the  old  styles,  through 
interference  with  the  circulation  by  local  pressure.  The  engraving 
-hows  two  elastics  on  each  side,  one  attached  to  the  cap  above 
and  one  belmv  the  ear.  The  points  of  attachments  are,  however, 
to  be  varied  according  to  the  requirements  of  the  case.  In  nearly 
'verv  instance  it  will  be  found  that  the  teeth  should  not  only  be 


72  THE   ANGLE    SYSTEM. 

moved  backward,  but  be  depressed  in  their  s(5ckets.  For,  if  merely 
moved  backward,  the  teeth  will  present  such  a  lengthened  appear- 
ance that  the  result  will  be  nearly  as  bad  as  the  original  deformity. 
Therefore,  it  would  be  plain  to  any  careful  observer  of  these  cases 
that  the  plan  so  often  advocated,  of  exerting  force  from  the  molars 
only,  is  wrong,  for  tipping  of  the  anterior  teeth  is  the  only  result 
by  anchorage  from  that  point;  but  with  the  occipital  anchorage 
there  is  perfect  control  over  the  direction  of  the  force,  by  simply 
making  the  attachments  to  the  anterior  elastics  farther  forward  or 
backward.  Or  if  elongation  of  the  teeth  be  necessary,  the  lower 
ligature  only  is  used,  dispensing  with  the  upper  or  using  only  a 
very  light  one.     These  ligatures  may  be  doubled  after  the  patient 

Fig.  86. 


has  become  well  accustomed  to  wearing  them.  The  teeth  are  to 
be  retained  by  the  wire  arch.  Fig.  84  (the  head-gear,  traction-bar, 
and  delicate  ligatures  being  of  course  dispensed  with),  which  is 
kept  in  position  by  passing  a  delicate  drill  through  the  tubes  on 
the  anchor-teeth,  and  inserting  neatly-fitting  pins  into  the  holes 
thus  made,  as  in  Fig.  23.  This  method  of  retaining  is  very 
efifectual,  and  as  long  as  the  appliance  is  so  worn  the  teeth  cannot 
change  their  proper  positions.  But  as  it  is  somewhat  unsightly, 
and  the  patient  has  already  worn  it  for  some  time,  its  removal  will 
be  requested;  and,  it  being  of  great  importance  in  these  cases  that 
the  teeth  be  firmly  retained  for  a  long  period  (at  least  one  year), 
a  device  less  objectionable  in  appearance  should  be  used.  After 
much  experimenting,  I  find  that  the  appliance  shown  in  Fig.  87 
effectually  meets  the  requirements.  It  is  retention  by  means  of 
the  occipital  bandage  or  head-gear,  but  should  never  be  made  use 
of  immediately  after  the  movement  of  the  teeth  has  been  accom- 


PRACTICAL    CASES.  y^ 

plished,  but  only  after  the  teeth  have  been  retained  by  the  other 
apphances  for  at  least  two  months,  or  long  enough  to  allow  the 
teeth  to  have  become  thoroughly  rested  in  their  new  positions  and 
somewhat  firmly  established.  The  arch,  bands,  and  tubes  upon 
the  molars,  as  well  as  on  the  incisors,  should  then  be  removed, 
and  the  teeth  thoroughly  cleansed.  After  which,  careful  impres- 
sions are  taken  of  both  upper  and  lower  jaws,  and  accurate  models 
made.  Careful  comparison  of  the  natural  teeth  with  these  models 
is  to  be  made  from  time  to  time,  in  order  to  detect  any  unfavorable 
changes  should  they  occur. 

The  retaining  appliance.  Fig.  87,  is  then  adjusted,  and  is  to  be 
worn  at  night-time  only,  thus  allowing  the  patient  entire  freedom 
from  all  appliances  during  the  day.  It  consists  of  a  segment  of 
the  wire  arch  (B)  long  enough  to  pass  in  front  of  the  incisors  and 
cuspids,  and  carefully  bent,  so  that  it  will  rest  in  contact  with  them. 

Fig.  ^7. 


Two  short  pieces  of  the  wire  G,  Set  No.  i,  are  soldered  at  right 
angles  to  this  wire,  opposite  the  front  of  the  central  incisors. 
They  are  long  enough  to  admit  the  ends  being  bent  over  the 
cutting-edges  of  the  incisors,  and  the  hooks  so  formed  will  hinder 
the  appliance  from  sliding  upward  against  the  gum.  The  device 
is  prevented  from  sliding  laterally  by  a  short  piece  of  the  G  wire 
soldered  at  a  point  between  the  centrals.  This  spur  should  rest 
in  the  depression  between  these  teeth;  the  opposite  end  forms  the 
delicate  ball  which  engages  the  socket  in  the  standard  of  the 
traction-bar,  all  accurately  shown  in  Fig.  87.  It  is  adjusted  by 
sliding  it  into  position  upon  the  teeth,  and,  if  it  has  been  carefully 
made,  will  not  be  displaced  after  the  head-gear  and  traction-bar 
have  been  adjusted.  This  device  may  also  be  made  of  vulcanite, 
having  a  spur  imbedded  at  the  proper  point  corresponding  with 
the  delicate  ball  which  engages  the  traction-bar. 

In  the  adjustment  of  Set  No.  2  it  is  usually  better  to  place  in 
position  only  the  anchor-bands  and  tubes  (D)  at  the  first  sitting, 
or  at  most  the  additional  bands  upon  the  incisors.  At  the  second 
sitting  the  arch  B  may  be  placed  in  position  and  worn  a  few  days 
until   the  patient   becomes  accustomed   to  wearing  it,  when   the 


74  THE    ANGLE    SYSTEM. 

head-gear  may  be  adjusted,  with  hght  tension  at  first,  graduaUy 
increasing  the  same,  as  well  as  the  number  of  hours  worn,  which 
should  finally  include  as  much  of  the  time  as  possible,  in  order  to 
expedite  the  completion  of  the  case. 

The  wire  arch  B  should  be  bent  occasionally  as  the  case  pro- 
gresses, in  order  to  exert  pressure  on  such  laterals  or  cuspids  as 
need  to  be  restrained  while  moving  back;  and,  if  any  of  the 
teeth  should  show  tendency  to  bunching  or  overlapping,  this 
should  be  prevented  by  lacing  them  to  the  arch,  after  plans  of 
ligatures  shown  in  Fig.  28.  If  any  of  the  teeth  show  tendency 
to  lengthening,  this  should  also  be  prevented  by  bands  and 
notches  which  shall  engage  the  arch  B.  Never  use  larger  liga- 
tures than  those  shown  at  E,  E,  Fig.  2,  as  the  force  necessary 
in  moving  the  teeth  is  exerted  by  the  heavy  elastics  and  head-gear; 
by  increasing  the  size  of  the  small  ligatures  disturbance  of  the 
anchor-teeth,  such  as  tipping,  elongating,  and  the  establishment 
of  faulty  occlusion  zvill  foUozv,  something  especially  to  be  avoided 
in  the  treatment  of  these  cases,  for  it  should  also  be  remembered 
that  no  moving  force  upon  the  teeth  should  be  exerted  by  these 
merely  retaining  ligatures. 

In  order  to  produce  room  for  the  protruding  teeth,  it  is  some- 
times necessar)^  to  extract  one  or  two  of  the  bicuspids.  Where 
the  loss  of  one  is  sufficient  the  moving  teeth  may  be  shifted 
laterally  in  order  to  fill  this  space,  by  inserting  a  folded  hand- 
kerchief or  a  small  cushion  between  the  face  and  heavy  elastic 
bands,  thus  exerting  lateral  pressure  upon  the  traction-bar  stand- 
ard and  wire  arch. 

The  wire  coder  shown  at  N,  Fig.  8  A,  is  well  adapted  for 
curving  the  retaining-wire  G,  or  for  modifying  the  curves  in 
wire  arches  B  and  E.  This  may  thus  be  done  without  risk  of 
breaking  or  roughening  the  smooth  surfaces  of  the  wires,  as  is 
hable  to  occur  under  the  use  of  ordinary  pliers. 

Section  IV.     Excessive  Protrusion  of  the  Lower  Teeth. 

Another  well-defined  type  of  irregularity  is  characterized  by 
excessive  prominence  of  the  lower  jaw,  or  orthognathism,  and 
which  in  extreme  cases  presents  the  most  noticeable  deformity  we 
are  called  upon  to  correct.  Unlike  the  type  last  described,  the 
inferior  dental  arch  is  generally  large,  and  quite  free  from  irreg- 
ularity, while  the  upper  arch  is  usually  small  and  the  teeth  crowded, 
so  that  the  inferior  incisors  close  anterior  to  the  superior,  pro- 
ducing the  greatest  malocclusion  of  the  remaining  teeth.     The 


PRACTJCAL    CASES. 


/O 


treatment  varies  according  to  the  age  of  the  patient.  If  begun 
at  a  proper  age,  as  soon  as  the  deformity  is  manifest,  or  even  up 
to  the  twelfth  or  fourteenth  year,  it  is  not  difficult  to  bring  about 
retraction  of  the  jaw  by  means  of  force  exerted  by  the  heavy  elastic 
bands  and  head-cap  (already  described  in  connection  with  Set 
Xo.  2),  attached  to  a  metallic  cap  covering  the  chin,  all  as  shown 
in  Fig.  5. 

Fic.  88. 


Fig.  88  represents  the  side  view  of  a  case  of  a  child  nine  years 
of  age.  The  permanent  incisors  of  the  lower  jaw  had  erupted; 
the  superior  centrals  had  also  erupted  and  were  twisted  nearly  at 
right  angles.  The  deciduous  cuspids  were  in  position,  although 
the  inferior  were  loosened  and  nearly  ready  to  fall  out.  The  four 
first  permanent  molars  were  present,  and  the  first  superior  bicus- 
pids were  beginning  to  emerge  from  the  gum.  The  jaw  had 
moved  forward  so  that  the  lower  incisors  closed  anterior  to  the 

Fic.  89. 


superior,  all  as  c(jrrectl\-  represented  in  ihe  engraving.  The 
patient  could  not  retract  the  jaw  sufficiently  lo  bring  the  cutting- 
edges  of  the  incisors  in  contact  at  any  point.  The  head-gear  and 
chin-cap  were  worn  almost  constantly  for  six  weeks. 

Double  rotatif)n  oi  the  superior  centrals  was  accomplished  by 
means  of  the  lever  already  described  in  double  rotation  (Fig.  34). 
They  were  retained  by  uniting  the  bands  with  solder  and  re- 
cementing  them  ujjon  the  teeth,  and  at  the  cu(\  of  six  weeks  the 
jaw  had  i)een  retracted  into  almost  a  normal  pf)sition.  presenting 
the  appearance  shown  in   I-'ig.  89.     The  chin-cap  and  head-gear 


76 


THE    ANGLE    SYSTEM. 


were  worn  at  night-time  only,  and  dispensed  with  after  six  months, 
as  there  was  no  further  need  of  retractive  force. 

The  first  examination  proved  the  patient  to  be  suffering  from 


Fig. 


Fig.  91. 


Fig.  92. 


greatly  enlarged  tonsils,  and  she  was  referred  to  the  rhinologist 
for  treatment. 

Fig.  90  shows  a  side  view  of  another  very  marked  case  belong- 


PRACTICAL    CASES. 


77 


ing  to  this  class  of  deformity.  Fig.  91  accurately  represents  the 
upper  arch.  The  effect  of  the  deformity  upon  the  appearance  of 
the  patient  is  shown  in  Fig.  92.  The  treatment  consisted  in  en- 
larging the  upper  arch  by  means  of  the  expansion-arch  E,  and 
anchor  clamp-bands  and  tubes  D,  operated  as  shown  in  the  case 
illustrated  in  Fig.  68.  The  expansion-arch  was  also  reinforced 
as  described  on  page  47  and  illustrated  by  Fig.  44. 

\\'hile  this  was  being  done,  the  head-gear  and  chin-retractor 
were  worn  as  much  of  the  time  as  possible.  At  the  end  of  two 
months  the  expansion  of  the  upper  arch  was  discontinued,  the 
teeth  retained,  and  the  patient  allowed  to  return  to  her  home  in 
a  distant  city,  for  a  vacation  of  three  months.     This  was  done  in 


Fig.  93. 


order  to  give  the  upper  jaw  an  opportunity  to  develop,  but  the 
wearing  of  the  chin-retractor  was  continued  faithfully.  At  the 
end  of  the  three  months  the  patient  returned,  and  the  expansion 
of  the  upper  arch  was  continued,  at  the  same  time  increasing  the 
tension  upon  the  chin.  At  the  end  of  two  months  more  the 
enlargement  of  the  upper  arch  had  been  completed,  and  is  truth- 
fully represented  in  Fig.  93. 

The  lower  jaw  had  been  moved  backward,  and  the  occluded 
teeth  presented  the  appearance  shown  in  Fig.  94. 

Exactly  what  changes  had  taken  place  in  the  angle  of  the  jaw, 
or  temporo-maxillary  articulation,  it  is  impossible  to  say,  but  I 
am  thoroughly  convinced  that  the  body  of  the  jaw  had  been  moved 
backward  greatly.  The  principal  change,  however,  was  the  instru- 
mental enlargement  of  the  upper  jaw.  The  improvement  in  the 
appearance  of  the  young  lady  can  be  better  imagined  than  de- 
^rribcd,  and  the  changes  that  had  been  brought  about  were  such 


78 


THE    ANGLE    SYSTEM. 


as  to  encourage  attempts  at  improvement  in  all  such  cases.  But 
in  cases  of  advanced  years,  my  experience  is  that  it  is  useless  to 
attempt  the  retraction  of  the  jaw.  All  that  we  can  then  hope  to 
accomplish  is  the  contraction  of  the  inferior  dental  arch  and  the 
enlargement  of  the  superior,  as  illustrated  by  the  case  shown  in 

Fig.  94. 


Fig.  95. 


Fig.  96. 


Fig.  95.  The  upper  anterior  teeth  were  moved  outward  by  means 
of  the  jack-screws  as  shown  in  position  upon  the  teeth  in  Fig.  96, 
and  described  in  the  treatment  of  a  similar  case  on  page  54.  After 
the  first  bicuspids  had  been  extracted,  contraction  of  the  anterior 
part  of  the  inferior  arch  was  accomplished  by  means  of  the  trac- 


rRACTlCAL    CASES. 


79 


tion-screws  hooked  into  staples  upon  bands  encircling  the  cuspids. 
The  traction-screws  were  assisted  in  moving  the  cuspids  and 
incisors  backward  by  the  head-gear,  elastics,  and  traction-bar, 
exerting  pressure  upon  a  section  of  the  wire  arch  B,  Set  No.  2, 
which  rested  in  contact  with  the  incisors  and  cuspids  held  in 
position  by  the  attachment  of  the  band  to  the  ends  with  solder,  all 

Fig.  97. 


as  shown  in  Fig.  97.  The  external  force  served  the  double  pur- 
pose of  assisting  the  traction-screws  in  moving  the  teeth  as  well 
as  in  the  retraction  of  the  maxilla.  The  amount  accomplished  in 
the  last-mentioned  movement  was  cjuite  noticeable,  as  is  well 
shown  in  Fig.  98,  wliich  represents  the  completed  case. 

Fig.  98. 


The  new  regulating  pliers  (H,  Fig.  8  I>)  for  elongating  the 
several  straight  or  curved  wire  appliances  will  be  more  and  more 
appreciated  as  experience  shall  demonstrate  the  general  utility 
of  the  invention.  A  re-examination  of  the  devices  shown  in 
l-igs.  10,  24,  25,  26,  37,  56,  70,  and  71  will  make  obvious  the  fact 
that  any  section  of  the  wire  G,  if  inadvertently  cut  a  little  short 
for  its  designed  position,  may  be  repeatedly  pinched  with  the  pliers 


8o  THE    ANGLE    SYSTEM. 

until  its  length  shall  exactly  correspond  with  its  function.  If 
desirable,  the  wire  may  be  so  stretched  while  in  situ,  as  shown  and 
described  on  page  51. 

In  the  precise  adjustment  of  retaining-wires  the  novel  action 
of  the  regulating  pliers  is  especially  manifest. 


CHAPTER  VIII. 

GENERAL   SUGGESTIONS. 


I.  An  essential  preliminary  to  the  treatment  of  a  case  is  a  clear 
conception  of  what  is  necessary.  This  can  be  gained  only  by  a 
careful  study  of  both  models  and  natural  teeth,  occlusion  and 
facial  expression,  history,  etc. 

II.  It  is  best  to  first  attend  to  the  crowding  teeth,  rather  than 
those  most  irregular.  For  example:  If  the  molars  and  bicuspids 
are  irregular,  and  expansion  indicated,  expand  first  and  establish 
correct  occlusion  in  that  region,  before  correcting  malpositions  of 
the  incisors  and  cuspids. 

III.  Have  regular  times  for  seeing  the  patient;  be  punctual, 
and  insist  upon  punctuality  by  the  patient.  Always  carefully  com- 
pare the  original  models  at  each  sitting. 

IV.  It  is  not  enough  to  correct  the  malpositions  of  the  teeth  in 
one  arch,  but  also  to  establish  the  correct  occlusion  of  all  the  teeth 
and  restore  proper  facial  expression. 

V.  Exercise  such  care  and  judgment  in  the  adjustment  of  the 
appliances  that  delays  from  slipping,  breaking,  or  changes  will  be 
avoided. 

VI.  In  moving  a  tooth,  the  best  result  is  obtainable  only  by 
recognizing  the  regular  and  proper  amount  of  force  necessary  to 
stimulate  absorption.  The  practice  of  applying  great  force  at 
irregular  intervals  serves  only  to  defeat  the  desired  object,  for  it 
retards  absorption  and  restoration,  causes  unnecessary  pain,  ex- 
cites inflammation,  and  thereby  endangers  pulp-life.  It  also 
strains  the  appliances,  causing  much  delay  and  pain  to  the  patient 
by  repairs. 

Whether  the  pressure  be  constant  or  irregular,  a  safe  rule  is  to 
see  that  it  in  no  instance  exceeds  a  snug  feehng,  which  is  a  true 
indication  of  the  proper  amount  of  force. 

VII.  When   the   screw  is   used  in   moving  a  tooth,   and  the 


GENERAL    SUGGESTIONS.  »I 

patient  is  an  intelligent  one,  he  may  be  provided  with  a  wrench, 
and  instructed  to  tighten  the  nut  each  morning,  thus  greatly  econo- 
mizing the  time  of  both  patient  and  operator;  yet  the  patient 
should  be  seen  at  intervals;  usually  twice  a  week  will  be  sufficient. 
Ylll.  It  is  important  that  the  patient  shall  observe  care  in 
brushing  and  cleansing  the  teeth  while  wearing  the  regulating  ap- 
pliances. If  the  appliances  are  kept  properly  cleansed,  they  will, 
in  most  instances,  take  on  a  beautiful  bronze  color,  far  more  pleas- 
ing in  appearance  than  when  made  of  gold,  besides  possessing 
greater  strength. 

IX.  Each  succeeding  year  strengthens  the  conviction  that  ex- 
traction for  space  is  a  rare  necessity,  and  moreover  it  is  difficult  to 
produce  the  best  results  without  the  full  complement  of  teeth. 
With  but  few  exceptions  it  will  be  found  that  the  facial  expression 
is  too  full  when  all  the  teeth  are  ideally  arranged  in  the  arches. 
The  conservative  method  should  be  first,  extraction  last.  Many 
C8se§  are  greatly  complicated  by  the  careless  extraction  of  one  or 
more  teeth,  in  order  to  gain  sufficient  space.  The  author  has  never 
seen  a  case  where  the  extraction  of  the  first  molar,  one  or  more, 
has  not  been  followed  by  more  or  less  irregularity,  sometimes  of  a 
very  complicated  nature.  No  one  can  long  practice  orthodontia 
without  l)eing  impressed  with  the  important  relation  that  each 
tooth  in  either  arch  bears  to  all  the  rest,  nor  fail  to  note  the  disas- 
trous results  often  following  the  loss  of  a  single  tooth. 

X.  Slight  irregularities  should  be  corrected,  because  the  turn- 
ing of  a  slightly  twisted  tooth,  or  the  correction  of  any  irregularity 
of  the  oral  teeth,  will  not  only  improve  their  appearance  and  occlu- 
sion, but  refine  the  whole  facial  expression. 

XI.  It  is  important  to  remember  that  the  pressure  should 
never  be  wholly  relinquished.  The  movements  of  a  tooth  may  be 
arrested  as  often  as  is  necessary;  but  never,  by  the  removal  of 
pressure,  allow  the  tooth  to  .spring  backward,  thus  interfering  with 
the  process  of  repair.  Disregard  of  this  principle  (as  has  usually 
been  necessary  in  the  ordinary  regulating  appliances,  the  faulty 
principles  on  which  their  construction  has  been  based  necessitat- 
ing their  frequent  removal  for  purposes  of  modification  and  cleans- 
ing) has  been  the  occasion  of  nearly  all  the  pain  and  soreness  in 
regulating.  If  intelligently  conducted,  the  movement  of  a  tooth 
is  painless. 

XII.  Another  very  important  fact  to  be  remembered  is,  that 
support  and  perfect  rest  arc  essential,  after  a  tooth  has  been 
moved  into  the  desired  position. 

XTII.     In  adopting  this  system  the  ojjerator  should  carefully 

6 


82  THE   ANGLE    SYSTEM. 

Study  and  thoroughly  familiarize  himself  with  the  names  and  uses 
of  all  the  parts  of  these  appliances,  which  are  supplied  in  sets  or 
separately.  A  little  experience  will  enable  him  to  readily  apply 
them  to  any  case,  for  the  system  is  complete  in  itself. 

XIV.  The  plate  has  no  place  in  this  system  as  any  part  of  a 
regulating-  appliance,  and  only  in  rare  instances  as  a  retainer  after 
lateral  expansion  of  the  arch :  it  should  be  a  relic  of  the  past. 

XV.  The  wire  arches  B  and  E  have  all  the  spring  possible. 
They  are,  therefore,  hard,  and  may  be  broken  if  care  is  not  taken 
in  bending  to  the  desired  shape.  They  are  made  long  enough  to 
include  the  largest  arch,  and  may  be  cut  to  suit  the  smaller  ones. 

XVI.  In  applying  the  jack-screw,  the  sheath  should  be  used 
as  long  as  possible,  turning  the  nut  close  up  to  the  chisel  end  be- 
fore cutting  the  sheath  to  the  desired  length. 

XVII.  In  making  the  attachments  of  tubes,  they  should  be 
grooved  with  a  round  file  at  the  point  of  contact  to  make  a  strong, 
compact  appliance. 

XVIII.  The  motionless  retention  of  the  teeth  is  of  great  im- 
portance, but  it  will  seldom  be  attained  unless  proper  occlusion 
has  been  first  established.  A  retaining  appliance  should  be  so 
delicate  that  it  may  be  worn  without  inconvenience  to  the  patient 
until  perfect  firmness  has  been  established,  and  should  rarely  be 
under  the  control  of  the  patient. 

XIX.  It  is  not  necessary  to  separate  the  upper  from  the  lower 
teeth  by  some  contrivance  while  teeth  are  being  moved  out  of  in- 
lock,  so  that  the  occlusion  will  not  cause  interference  with  the 
moving,  teeth.  The  author  has  never  yet  found  it  necessary,  as 
the  patient  will  invariably  avoid  biting  upon  the  tender  moving 
teeth. 

XX.  Failures  to  recognize  and  appreciate  the  artistic  require- 
ments in  the  treatment  of  dental  irregularities  are  frequent,  and 
as  easily  recognized  as  they  are  lasting.  All  who  hope  to  attain 
success  in  the  treatment  of  dental  irregularities  should  cultivate 
the  habit  of  observing  and  carefully  studying  the  normal  and  ab- 
normal lines  of  the  human  face,  together  with  their  relations  to, 
and  dependence  upon,  the  teeth. 

An  appreciation  and  intelligent  application  of  the  principles  of 
art  must  ever  go  hand  in  hand  with  the  successful  treatment  of 
irregularities  of  the  teeth. 

XXI.  Irregularities  of  the  teeth  being  so  frequently  associated 
with  some  pathological  obstruction  of  the  nasal  passages,  or  naso- 
pharynx, this  fact  should  be  ever  present  in  the  operator's  mind 
and  suitable  examination  be  made;  and  in  case  (as  is  often  found) 


GENERAL    SUGGESTIONS.  83 

the  oral  deformity  is  complicated  by  the  presence  of  hypertrophied 
faucial  tonsils,  adenoid  hypertrophies  in  the  vault  of  the  pharynx, 
or  obstruction  of  the  nasal  passages,  the  orthodontist's  work  can 
only  be  made  complete  by  the  assistance  of  the  rhinologist  and 
laryngologist. 

XXII.  If,  however,  a  dentist,  after  sufficient  experience,  finds 
himself  unsuited  for  this  class  of  work,  it  is  his  duty  to  refer  pa- 
tients to  an  expert  orthodontist,  and  thus  promote  the  practice  of 
this  specialty  in  dental  surgery. 


84  THE    ANGLE    SYSTEM. 

PART     II. 

FRACTURES  OF  THE  MAXILLA. 


CHAPTER   I. 

TREATMENT   OF    FRACTl'RES   OF   THE   MAXILLA. 

The  limits  of  this  work  will  not  admit  of  a  general  discussion  of 
this  subject,  nor  is  it  deemed  necessary,  for  almost  any  of  the  mod- 
ern works  on  surgery  contains  a  treatise  covering  the  general  prin- 
ciples of  the  treatment  of  fractures.  Especially  commendable  is 
Hamilton  on  Fractures. 

The  most  important  consideration,  after  securing  perfect  apposi- 
tion of  the  parts,  is  that  they  shall  have  uninterrupted  rest,  and  this 

Fig.  99. 


phase  of  the  subject  will  be  set  forth,  strictly  with  reference  to 
certain  plans  for  securing  fixation  of  the  fractured  maxillae  while 
undergoing  the  healing  process ;  plans  which  are  original  with  the 
author,  and  have  been  successfully  employed  in  an  extensive  ex- 
perience in  the  treatment  of  these  lesions. 

The  first  plan  is  that  of  firmly  and  immovably  holding  the  in- 
jured jaw  in  contact  with  the  firm  and  uninjured  jaw,  by  means  of 
wire  ligatures  wrapped  in  the  form  of  the  figure  eight,  around 
buttons  attached  to  bands  encircling  suitable  opposite  or  nearly 
opposite  teeth,  as  shown  in  Fig.  99. 

All  the  teeth  are  thus  kept  in  perfect  occlusion,  and,  as  a  result, 
the  fractured  ends  of  the  bones  must  necessarily  be  in  apposition, 


TREATMENT    OF    FRACTURES    OF    THE    MAXILLA.  85 

SO  that  the  conditions  are  most  favorable  to  the  process  of  repair; 
for  it  will  be  apparent  upon  reflection,  that  no  matter  at  what  point 
the  fracture  has  occurred,  if  the  jaw  contains  sufficient  teeth  and 
they  are  placed  in  perfect  occlusion,  not  only  will  the  fracture  be 
properly  set,  but  the  powerful  muscles  will  be  greatly  relaxed  and 
tlie  parts  be  consequently  freed  from  that  tension  and  tendency  to 
displacement,  so  difficult  to  combat  in  the  treatment  of  fractures, 
in  the  long  bones  especially,  or  in  the  maxillae  when  the  jaws  are 
kept  apart,  as  is  necessary  when  the  heavy  interdental  splints  are 
employed. 

Indeed,  we  believe  this  plan  to  be  a  most  natural  and  easy  one, 
for  the  cusps  of  the  teeth  lock  and  interlace  so  perfectly  that  dis- 
placement in  any  direction  is  impossible,  provided  the  jaws  are  kept 
closed.  And  in  this  we  are  further  assisted  by  the  natural  contrac- 
tion of  the  powerful  muscles  of  mastication,  it  being  necessary  in 
most  cases  only  to  antagonize  the  anterior,  feeble  depressor  mus- 
cles, by  attachments  on  each  side  to  the  cuspids,  or  other  teeth  in 
this  region,  if  more  suitable. 

The  bands,  which  we  term  fracture-bands,  Fig.  lOO,  are  made 

Fig.   100. 


very  thin  and  strong,  are  adjustable,  and,  by  means  of  the  screw 
and  nut,  they  may  be  firmly  clamped  about  the  teeth.  Little 
buttons,  strong  and  of  sufficient  size  to  admit  the  requisite  number 
of  wraps  of  the  ligatures,  are  firmly  soldered  to  the  band.  Care 
should  always  be  exercised  to  work  the  band  well  over  the  crown 
of  the  tooth  and  down  upon  the  neck,  then  tighten  the  nut  until 
the  band  is  firmly  clamped,  being  careful  not  to  weaken  the  band 
by  crimping  or  tearing.  The  fingers  alone  are  usually  sufficient, 
although  a  dull  instrument  and  mallet  (as  in  M  and  L,  Fig.  8  B) 
may  be  used  to  assist  in  placing  the  band.  If  the  teeth  are 
ciowded,  a  thin  spatula  pressed  between  them  and  allowed  to  re- 
main for  a  few  moments  will  i)rovide  ami)le  space.  For  the  liga- 
tures, almost  any  of  the  usual  materials  may  be  employed,  such  as 
waxed  floss  silk,  strong  linen  thread,  or  the  gut  ligature  so  exten- 
sively employed  in  surgery,  but  fine  copper  or  brass  wire  thor- 
oughly annealed  (No.  26)  is  j)rc-fcrable  on  account  of  its  strength, 
pliability,  and  cleanliness. 


86 


THE    ANGLE    SYSTEM. 


That  the  reader  may  become  more  famihar  with  this  method  of 
treatment,  as  well  as  with  a  few  of  the  many  modifications  of  which 
it  is  susceptible,  reports  of  a  few  cases  from  practice  are  subjoined, 
with  illustrations  from  models  made  accurately  in  each  instance 
after  treatment. 

Case  I. — The  first  is  represented  by  Fig.  loi. 

On  July  14,  1889,  Wm.  Fraley,  aged  forty-five,  was  admitted  to 
the  Minneapolis  City  Hospital.  A  blow  from  a  policeman's  club 
had  produced  one  simple  and  one  compound  fracture  of  the  inferior 
maxilla.  The  first  was  an  oblique  fracture  on  the  right  side,  be- 
ginning with  the  socket  of  the  second  bicuspid,  extending  down- 
ward and  backward,  and  involving  the  socket  of  the  first  molar. 
The  second  bicuspid  had  fallen  out,  and  the  first  molar  was  much 

Fig.  ioi. 


loosened.  The  second  molar  had  been  lost  years  before,  while  the 
third  molar  and  the  remaining  teeth  were  much  abraded,  and  much 
loosened  by  salivary  calculus.  The  second  fracture  was  on  the  op- 
posite side,  high  up  in  the  ramus  of  the  jaw.  I  could  not  detect  the 
exact  course  the  line  of  fracture  had  taken,  but  the  crepitation  of 
the  ends  of  the  bones,  and  the  pain  occasioned  thereby,  were  un- 
mistakable evidences  of  a  fracture.  The  patient,  as  is  usual  in  such 
cases,  was  unable  to  close  his  jaws.  The  fractured  parts  on  the 
right  side  were  widely  separated,  and  the  anterior  piece  much 
depressed  by  reason  of  the  action  of  the  digastric  muscle,  the  pos- 
terior piece  of' bone  being  drawn  firmly  up,  and  the  molars  occlud- 
ing by  reason  of  the  contraction  of  the  masseter  muscle.  He  was 
treated  as  follows : 

Bands  were  made  to  encircle  all  four  of  the  cuspids  (they  being 
most  firmly  attached  in  their  sockets).     The  fractured  ends  of  the 


TREATMENT    OF    FRACTURES    OF    THE    MAXILL/E.  87 

bones  were  placed  in  careful  apposition,  and  the  lower  jaw  closed, 
the  lower  teeth  being  correctly  occluded  with  the  upper. 

The  points  on  the  bands,  where  the  little  tubes  (C,  Set  No.  i) 
shown  in  the  engraving  should  be  attached,  were  carefully  noted 
and  marked.  The  bands  were  slipped  ofif  and  the  tubes  soldered 
to  them,  after  which  the  bands  were  cemented  in  proper  position 
upon  the  teeth,  and  two  small  traction-screws  (B,  Fig.  i),  shown 
in  the  engraving,  inserted  in  the  tubes.  The  jaws  were  closed  and 
the  nuts  tightened. 

During  an  attack  of  coughing  the  following  night,  one  of  the 
bands  was  loosened,  but  it  was  easily  replaced  the  next  day.  No 
further  accident  or  trouble  occurred,  the  patient  readily  taking 
nourishment  through  the  spaces  between  the  teeth.  Thus  the 
fractured  jaw  was  firmly  supported  without  motion  for  twenty-two 
days,  when  the  appliance  was  removed,  showing  most  excellent 
results. 

That  the  patient  was  a  great  lover  of  the  clay  pipe  is  shown  in 
the  engraving,  by  the  much  worn  ends  of  the  lateral  incisors,  which 
resulted  from  holding  the  stem  of  the  pipe.  While  wearing  the 
appliance  he  was  not  debarred  from  his  favorite  enjoyment, 
although  compelled  to  grasp  the  stem  between  his  lips  instead  of 
the  teeth. 

Case  II. — December  28,  1889,  Thomas  Bremen  was  admitted  to 
the  Dental  Infirmary  of  the  University  of  Minnesota,  suffering 
from  the  efifects  of  a  blow  received  on  the  left  side  of  the  jaw  from 
a  cant  hook,  while  working  in  a  lumber  camp.  The  result  was 
two  fractures  of  the  jaw. 

The  first  fracture  was  on  the  right  side,  beginning  between  the 
first  and  second  bicuspids,  and  extending  downward  and  backward 
so  far  as  to  involve  the  lower  part  of  the  anterior  root  of  the  first 
molar.  The  second  was  on  the  left  side  directly  through  the  angle 
of  the  jaw  (see  Fig.  102).  The  accident  had  occurred  thirty-two 
days  previous  to  his  admission  to  the  infirmary,  during  which  time 
nothing  had  been  done  to  reduce  the  fracture.  He  reported  that 
he  had  called  upon  a  physician,  who  supposed  the  trouble  was 
merely  an  abscessed  tooth,  and  had  lanced  the  gum  with  a  view 
of  reducing  the  swelling.  Later,  the  patient  had  called  upon  a 
dentist  in  one  of  the  smaller  towns,  who  also  failed  to  diagnose 
the  fracture,  and  extracted  hnth  bicuspids  in  the  hope  of  giving 
relief  Csee  Fig.  99). 

Upon  examination,  T  found  considerable  swelling  in  the  region 
of  the  fracture,  with  the  usual  result;  the  patient  being  unable  to 
close  his  mouth,  bv  reason  of  the  anterior  piece  of  the  fractured 


88 


THE   ANGLE    SYSTEM. 


bone  being  drawn  down  by  the  depressor  muscles.  A  false  joint 
had  also  become  established,  and  could  be  easily  moved  without 
causing  pain.  At  the  fracture  of  the  right  side  there  was  but  little 
displacement;  the  swelling  also  was  slight. 

The  patient  was  anesthetized,  and,  with  a  view  to  breaking  up 
the  false  attachments  and  stimulating  activity  in  repair,  the  ends 
of  the  bones  rubbed  forcibly  together,  placed  in  perfect  apposition 
and  the  jaw  closed,  great  care  being  taken  to  articulate  the  teeth 
correctly  with  the  upper  ones.  The  jaw  was  now  firmly  bound  in 
this  position  in  the  same  manner  as  described  and  shown  in  Fig, 
99,  which  is  quite  as  efficient  and  much  easier  to  adjust.  Four 
bands  were  used,  encircling  the  four  cuspids  as  shown  in  Fig.  102, 


Fig.  102. 


The  bands  shown  upon  the  molars  in  the  engraving  were  not 
used,  as  I  found  them  unnecessary,  since  the  jaws  were  firmly 
supported  by  the  four  anterior  bands  alone. 

Case  No.  3  is  represented  by  Fig.  103,  and  is  that  of  a  healthy 
young  Swede,  twenty-two  years  of  age,  who,  while  washing  win- 
dows, had  fallen  from  the  second  story  to  the  hard  pavement.  Be- 
sides receiving  several  minor  injuries  he  sustained  a  double  fracture 
of  the  lower  jaw,  one  extending  from  between  the  central  incisors, 
and  one  posterior  to  the  second  molar,  the  third  molar  having 
been  extracted.  The  right  superior  lateral  and  cuspid  were 
knocked  out,  the  first  bicuspid  broken  off  near  the  neck,  and  the 
alveolar  process  badly  shattered.  The  centrals  and  left  lateral  were 
bent  inward  and  forced  deeper  into  their  sockets.  He  had  been 
treated  by  the  attending  physician  at  the  City  Hospital,  the  method 
employed  being  that  of  the  Barton  style  of  bandaging,  with  the 
usual  result,  when  the  bandage  is  employed  in  such  cases,  of  aggra- 


TREATMENT    OF    FRACTURES    OF    THE    MAXILL/E. 


89 


\'ating  the  condition  b\-   forcing  the  pieces  inward  and  the  jaw 
backward. 

Upon  examination  three  weeks  after  the  accident.  I  found  nuicli 
displacement.  The  jaw  was  drawn  backward  and  the  right  middle 
section  of  the  bone  tipped  inward.  No  attention  had  been  paid  to 
the  bent  and  broken  condition  of  the  superior  alveoH.  The  teeth 
had  become  quite  firm  in  their  new,  but  abnormal  positions,  and 
I  allowed  them  to  remain  so.  A  fibrous  attachment  had  been 
established  in  the  lower  fracture,  which  admitted  of  considerable 
movement,  and  occasioned  but  little  pain.  There  was  much 
sw-elling,  and  pus  was  discharging  into  the  mouth  from  the  anterior 
fracture.     I  found  it  impossible  to  restore  normal  occlusion  at  that 


Fig.  103. 


time.  Bands  were  made  to  encircle  the  four  bicuspids,  and  be- 
tween the  two  lower  bands,  on  the  inside  of  the  mouth,  was  placed 
one  of  the  jack-screws  (E  and  J,  Set  No.  i),  held  in  place  by  the 
staple  and  spur  (E,  Fig.  21,  and  B,  Fig.  20).  The  nut  was  tight- 
ened until  the  piece  of  bone  had  been  tipped  outward  about  one- 
half  the  distance  to  its  normal  position,  but  the  operation  caused 
so  much  pain  that  further  movement  was  flcferred.  The  jaws 
were  then  closed  and  the  buttons  connected  by  ligatures,  but  occlu- 
sion was  far  from  being  normal.  On  the  next  day,  by  again 
tightening  the  nut  on  the  jack-screw  and  with  renewed  ligatures 
bound  very  tightly,  I  was  enabled  to  secure  nearly  the  normal 
occlusion.  On  the  third  day  following,  by  the  same  means,  cor- 
rect occlusion  was  established.  The  jack-screw  was  allowed  to 
remain  in  position  to  steady  the  tipj^ing  section. 

The  abscess  was  frequently  syringed  with  fresh  peroxid  of  hydro- 
gen,    A  few  fragments  of  bone  were  washed  out.     The  fractures 


90 


THE    ANGLE    SYSTEM. 


readily  united,  and  on  the  twenty-seventh  day  the  jaw  was  released 
and  found  to  be  quite  firm. 

Case  No.  4  shows  another  modification,  and  is  represented  by 
Fig.  104.  A  young  machinist  received  a  severe  blow  from  the  fist 
of  an  antagonist,  by  which  two  compound  fractures  were  sustained; 
one  posterior  to  the  first  molar,  the  other  in  the  region  of  the 
cuspid,  which  was  involved  and  greatly  loosened.  Occlusion  was 
established  and  maintained  in  the  previously  described  way.  Sup- 
puration occurred  in  both  fractures  on  about  the  tenth  day,  and 
received  proper  treatment.  The  union  of  the  anterior  fragment 
was  slow,  as  the  patient  was  troubled  by  a  persistent  hacking 
cough,  which  occasioned  a  slight  movement  between  the  ends  of 
the  bone,  just  sufficient  to  interfere  with  the  healing  process.     On 


Fig.  104. 


the  twentieth  day  the  ligatures  were  cut,  a  jack-screw  placed  in 
position  between  the  bands  on  the  inside  in  the  same  manner  as 
in  Fig.  103,  with  an  additional  ligature  firmly  connecting  the  two 
buttons  on  the  lower  bands,  and  resting  in  contact  with  the  labial 
surfaces  of  the  intervening  teeth.  This  additional  support  proved 
successful;  the  union  proceeded  slowly,  and  was  found  complete 
when  the  bands  were  removed  on  the  sixty-second  day  after  the 
accident. 

Another  modification  is  shown  in  a  somewhat  peculiar  case, 
represented  in  Fig.  105.  The  patient,  a  man  of  about  forty  years 
of  age,  had  sustained  a  complete  fracture  of  the  left  angle  of  the 
jaw,  as  the  result  of  a  kick  from  a  horse.  The  jaw  was  enormously 
large  and  protruding,  and  the  occlusion  so  unusually  faulty  that  I 
was  at  a  loss  to  determine  what  the  patient's  normal  occlusion  was; 


TREATMENT    OF    FRACTURES    OF    THE    MAXILLAE. 


91 


but  upon  questioning  him,  he  informed  me  that  when  a  boy  of  ten 
years  he  had  been  hit  with  a  stone,  causing  a  fracture  on  the  right 
side  of  the  jaw,  which  had  been  allowed  to  heal  without  any  treat- 
ment. This  statement,  with  the  worn  facets  upon  the  cusps  of 
some  of  the  teeth,  and  the  readiness  with  which  they  occluded  only 
at  these  points,  showed  conclusively  the  position  in  which  the  jaw 
niust  be  secured.  I  at  first,  of  course,  supposed  that  the  usual 
number  of  four  bands  and  two  ligatures  would  be  necessary,  but 
I  found  the  single  ligature,  as  shown,  was  quite  sufficient  to  firmly 
retain  the  jaw  in  this  abnormally  normal  position.  The  jaw  was 
set  a  few  hours  after  the  accident.  Very  little  swelling  ensued,  the 
fractured  parts  uniting  rapidly.  I  saw  the  patient  but  four  times, 
and  removed  the  bands  on  the  twentieth  day,  as  further  support 

Fig.  105. 


seemed  unnecessary.  1  admonished  him,  however,  to  avoid  using 
his  jaw  as  much  as  possible  for  at  least  ten  days  thereafter. 

Fig.  106  represents  a  case  where  the  patient  suffered  in  a  railroad 
wreck  two  compound  fractures  of  the  inferior  maxilla,  one  on  each 
side,  posterior  to  the  second  molar.  The  left  side  was  quite  badly 
comminuted.  The  full  complement  of  teeth  was  present,  with  the 
exception  of  the  third  molars.  The  occlusion  of  all  the  teeth  was 
excellent.  The  incisors,  however,  were  crossed  (not  well  shown 
in  this  engraving);  that  is,  the  left  superior  central  and  lateral 
closed  just  inside  of  the  points  of  the  lower  incisor  and  cuspid, 
while  the  right  central  and  lateral  closed  just  outside  of  the  points 
of  the  opposing  lower  cuspifl,  central,  and  lateral. 

The  teeth  being  so  perfect  and  the  occlusion  so  accurate,  liquid 
U)f)(h  only  were  pfjssiblc     TIk-  iDiiditioiis  were  made  mr)r<'  un- 


92 


THE    ANGLE    SYSTEM. 


favorable  on  account  of  the  patient  suffering  from  severe  spinal 
injury  received  at  the  time  of  the  accident,  but  with  the  exception 
of  considerable  suppuration  in  the  left  fracture,  which  yielded 
readily  to  treatment,  nothing  unusual  occurred.  The  ligatures 
were  removed  on  the  fortieth  day,  and  excellent  results  were  ap- 
parent. 

It  might  be  urged  against  a  method  of  treatment  which  involves 
the  closure  of  the  teeth  and  the  binding  of  the  jaws  firmly  together, 
that  the  patient  would  be  unable  to  take  sufficient  nourishment. 
Experience,  however,  shows  that  this  argument  has  practically  no 
foundation,  for  it  rarely  happens  that  a  patient  is  found  without 
some  missing  teeth,  thereby  providing  abundant  opportunity  for 
the  inception  of  all  ordinary  chopped  foods,  and  more  especially 

Fig.  io6. 


for  the  large  number  of  foods  now  available  in  liquid  form.  Even 
when  all  the  teeth  are  sound  and  in  perfect  position,  there  is  plenty 
of  space  between  the  teeth,  or  behind  the  molars  and  between  the 
upper  and  lower  incisors,  for  taking  all  the  nourishment  necessary. 
Of  course,  in  these  rare  cases  more  time  would  be  required  for 
eating.  This  inconvenience  is  very  slight  when  we  consider  the 
advantages  of  freedom  from  an  uncleanly,  bulky,  and  inconvenient 
apparatus  within  the  mouth,  often  accompanied  by  the  disfigure- 
ment of  bandages  and  splints  without,  as  well  as  the  great  import- 
ance of  the  accuracy  in  results  which  it  assures,  so  uncertain  of 
attainment  in  many  other  methods  commonly  employed. 

There  is  also  another  class  of  lesions  in  the  treatment  of  which 
this  plan  of  fixation  may  be  employed  to  great  advantage.  I  refer 
to  excision  of  the  lower  maxilla,  or  those  cases  where  a  large 
portion  of  the  jaw  has  been  removed,  as  in  Fig,  107, 


TREAT-MEXT    OF    FRACTURES    OF    THE    MAXILL.E. 


93 


In  all  these  cases  there  is  a  strong  tendency  for  the  remaining 
portion  of  the  jaw  to  be  drawn  greatly  to  one  side  (about  three- 
quarters  of  an  inch,  by  actual  measurement,  in  the  case  repre- 
sented), due  to  the  contraction  of  the  cicatricial  tissues  following 
the  healing  of  the  wound.  The  plan  I  propose  will  prevent  this 
contraction,  by  securing  the  remaining  portion  of  the  jaw  in  proper 
occlusion,  by  means  of  the  fracture-bands  and  ligatures  in  the 
manner  already  described.  The  jaw  thus  firmly  held  will  exert 
sufficient  tension  upon  the  healing  muscles  to  prevent  their  con- 
traction. I  would  also  suggest  the  advisability  of  increasing  the 
tension  by  the  attachment  of  a  plumper,  by  means  of  a  clamp-band, 
to  one  of  the  molars  in  the  upper  jaw  on  the  side  from  which  the 
section  has  been  removed,  allowing  the  shield  or  plumper  to 
extend  downward  and  outward,  to  occupy  somewhat  the  position 

Fig.  107. 


of  the  missing  bone.  This  shield  may  also  serve  a  useful  purpose 
in  holding  in  better  position  the  dressing  of  the  wound. 

The  next  plan  may  be  said  to  be  a  modification  of,  or  an  im- 
provement upon,  the  plan  advocated  by  Hippocrates  in  the  fifth 
century  B.C.,  and  which  has  been  employed  from  that  time  to 
this.  It  consists  in  holding  the  fractured  ends  of  the  bone  in 
apposition  by  wrapping  ligatures  about  the  teeth,  or,  as  physi- 
cians now  term  it,  wiring  the  teeth.  The  principal  disadvantage 
has  always  been  the  slipping  of  the  ligatures,  which  produced 
displacement  of  the  bones,  and  caused  inflammation  by  the  pres- 
sure of  the  sliding  ligature  upon  the  gums. 

My  plan  is  shown  in  Fig.  108,  and  consists  in  encircling  suitable 
teeth  with  fracture-bands  and  attaching  ligatures  to  the  buttons 
upon  the  bands,  so  that  loosening  of  tlic  !)ones  or  pressure  upon 
the  gums  is  impossible. 


94 


THE   ANGLE    SYSTEM. 


A  modification  of  the  plan  is  shown  in  Fig.  109,  in  which  addi- 
tional support  is  secured  by  connecting  the  labial  and  lingual  wire 
ligatures  by  loops  of  wire  passed  between  the  teeth,  with  their  ends 
united  by  twisting. 

In  favorable  cases,  as  in  simple  transverse  fractures  with  little 
or  no  displacement  and  where  the  teeth  are  very  firm,  if  the 
apparatus  is  adjusted  with  skill,  the  plan  will  be  found  valuable, 
as  it  is  very  neat,  clean,  and  compact,  and  does  not  interfere  with 
the  freedom  of  the  jaw. 

A  few  suggestions  may  assist  the  inexperienced  in  the  adjust- 
mient  of  the  apparatus,  so  that  it  will  surely  afford  equal  pressure 
and  support  upon  the  intervening  teeth.  The  only  difBculty  is  in 
regard  to  the  proper  length  of  the  lingual  ligature  when  completed. 

Fig.  108. 


This  is  easily  overcome  by  using  two  small  copper  wires,  passing 
respectively  above  and  below  the  buttons  and  extending  beyond 
them  a  half-inch  or  more  at  each  end.  Tension  is  not  exerted 
on  the  buttons  by  uniting  the  ends  by  twisting  until  after  the 
external  and  transverse  ligatures  have  been  completed.  The 
engraving  is  incorrect  in  this  respect,  that  only  one  end  of  the 
lingual  ligature  shows  imion  of  the  ends,  instead  of  both. 

Fig.  no  represents  a  modification  of  this  plan  used  for  holding 
in  position  a  large  section  of  the  inferior  alveolus,  including  the 
incisors  and  left  cuspid,  which  had  been  broken  outward  as  the 
result  of  falling  from  a  sled  while  the  individual  was  coasting  with 
the  knotted  end  of  a  rope  held  in  the  mouth.  The  second  bicus- 
pids were  banded,  and  a  wire  ligature  made  to  encircle  the  buttons 
and  bear  against  the  loosened  teeth.  The  ligatures  showed  a 
slight  tendency  to  slide  down  and  impinge  upon  the  gum,  but 
this  was  easily  remedied  by  encircling  the  main  ligature  and  the 
incisors  with  two  or  three  fine  wire  ligatures,  thus  giving  addi- 
tional support  in  a  downward  direction. 


TREATMENT    OF    FR.\CTURES    OF    THE    MAXILL.E. 


95 


Fig.  Ill  shows  another  plan  for  securing  fixation  which  pos- 
sesses several  valuable  features.  It  is  a  thin  metal  cap,  swaged 
to  fit  the  crowns  accurately  and  covering  a  sufficient  number  of 
the  teeth  in  the  arch  to  afford  the  necessar}^  support,  the  whole 
being  firmly  cemented  to  the  teeth  with  oxyphosphate  of  zinc. 
Copper,  gold,  silver,  aluminum,  or  vulcanite  may  be  used;  my 


preference  is  aluminum.  The  plan  is  excellent,  in  that  it  allows 
freedom  of  the  jaw,  is  very  clean  and  compact,  and  retains  the 
fractured  ends  of  the  bone  firmly  in  apposition.  Considering  the 
simplicity  of  this  appliance,  and  the  familiarity  of  dentists  with 
oxyphosphate  of  zinc,  it  is  surprising  that  the  value  of  this  idea  in 


treating  fractures  has  not  been  before  recognized;  but  I  find  no 
record  of  its  use,  although  dentists  frequently  use  similar  splints 
in  the  retention  of  teeth  after  they  have  been  regulated,  and  Hulli- 
hen  employed  a  similar  device  in  1848  to  hold  the  section  of  a  jaw 
after  a  surgical  operation,  using  ligatures  to  keep  the  appliance  in 
place. 

For  several  vears  T  supposed  T  had  been  the  first  to  employ 


9D 


THE   ANGLE    SYSTEM. 


this  method  of  retaining  fractures,  but  I  now  believe  it  was  first 
used  by  Dr.  John  H.  Martindale,  of  Minneapolis,  who  preceded 
me  a  year  or  so,  by  cementing  in  position  a  splint  made  after 
Kingsley's  pattern,  in  order  to  dispense  with  the  submental  cap 


Fig.  III. 


and  bandages,  which  would  interfere  with  the  treatment  of  serious 
external  wounds  on  the  side  of  the  face. 

My  first  case  treated  after  this  method  is  shown  in  Fig.   112. 
Michael  P.,  a  baker  by  trade,  had  fallen  down-stairs,  knocking 


Fig.  112. 


out  the  superior  incisors,  cuspids,  and  one  bicuspid,  also  loosen- 
ing the  lower  central  incisors  and  fracturing  the  jaw  at  the 
symphysis.  As  I  remember,  he  also  received  a  fracture  of  one 
of  the  femurs.      He  was  admitted  to  the  Minneapolis  City  Hos- 


TRE.-\TMENT    OF    FRACTURES    OF    THE    MAXILLAE.  97 

pital  some  time  in  June,  1888.  I  saw  him  first  some  two  months 
after  the  accident  occurred,  during  which  time  the  attending  sur- 
geon had  employed  the  Barton  style  of  bandaging  in  treatment. 
Union  of  the  bone  had  not  taken  place;  on  the  contrary,  a  com- 
plete fibrous  joint  had  been  established,  with  the  ends  of  the  bones 
more  or  less  absorbed  and  rounded,  admitting  of  a  free  hinge 
movement,  with  pus  discharging,  for  which  a  large  rubber  drain- 
age-tube had  been  inserted.  The  tube  was  removed,  the  wound 
thoroughly  washed,  and  an  impression  taken  without  any  attempt 
at  changing  the  collapsed  condition  of  the  sides  of  the  arch.  A 
model  was  made  and  sawed  through  at  the  point  of  fracture.  It 
was  then  placed  in  the  articulator  and  adjusted  to  restore  the  origi- 
nal occlusion  as  nearly  as  possible.  Over  this  readjusted  model  a 
very  thin  vulcanite  splint  was  formed,  the  outlines  of  which  cor- 
respond to  the  dotted  lines  in  the  engraving. 

Fig.  113. 


The  first  attempt  at  cementing  it  in  position  upon  the  teeth  was 
unsuccessful,  the  cement  hardening  too  rapidly,  but  the  next 
proved  successful.  The  splint  remained  in  position  without  any 
trouble  for  nearly  four  months,  when  it  worked  loose,  and  we 
found,  upon  examination,  that  firm  union  had  taken  place. 

Of  course  the  range  of  usefulness  of  this  splint  is  quite  limited, 
as  a  sufficient  number  of  firm  teeth  must  be  present  on  each  side  of 
the  fracture.  Its  principal  value  will,  I  think,  be  found  in  treating 
fractures  in  the  anterior  part  of  the  jaw,  more  especially  in  that 
class  of  cases  resulting  from  gunshot  wounds  in  which  large  sec- 
tions of  the  alveolus  have  been  carried  away. 

Another  plan  which  I  have  made  use  of  in  a  few  favorable  cases 
with  much  satisfaction  is  shown  in  Fig.  113,  which  represents  my 
first  case  treated  by  the  method  in  (juestion.  On  May  29,  1889,  a 
young  man  of  twenty-one  years  was  admitted  to  the  St.  Anthony 
Hospital  of  Minncai)olis.  During  an  attack  of  epilepsy  he  had 
fallen  from  a  lumber  pile  to  the  groniul,  a  distance  of  fifteen  or 

7 


98  THE    ANGLE    SYSTEM. 

twenty  feet.  Besides  receiving  severe  bruises,  he  sustained  a  com- 
pound fracture  at  the  symphysis,  terminating  in  front  between  the 
central  and  lateral,  as  shown  by  the  line  in  the  engraving.  The 
fractured  bone,  when  first  seen,  was  quite  widely  separated  at  the 
top,  and  the  left  central  incisor  was  much  loosened.  He  was 
treated  as  follows :  The  ends  of  the  fractured  bones  were  carefully 
placed  in  apposition  and  temporarily  fastened  by  lacing  the  teeth 
together  with  silk  ligatures.  The  cuspids,  being  very  firm,  were 
carefully  fitted  with  plain  bands.  Tubes  were  soldered  to  these 
bands  horizontally.  The  large  traction-screw  shown  at  A,  Fig.  i, 
was  now  slipped  through  the  tubes,  and  the  bands  were  firmly 
cemented  in  position  upon  the  teeth.  The  nut  was  then  turned 
upon  the  screw  until  the  fractured  ends  of  the  bones  were  drawn 
snugly  together.  This  appliance  was  worn  without  displacement 
or  further  trouble  for  twenty-one  days,  when  it  was  removed,  the 
bones  having  become  firmly  united. 

I  may  add  that  during  the  time  the  appliance  was  worn,  so  firmly 
was  the  jaw  supported  that  the  patient  suffered  but  little  incon- 
venience, and  after  the  third  day,  partook  regularly  of  his  meals, 
using  his  jaws  freely,  but  of  course  avoiding  the  very  hard  foods. 


CHAPTER    II. 

FINAL    SUGGESTIONS    ON    FRACTURES. 

In  adjusting  bands  for  the  treatment  of  a  fracture,  carefully  con- 
sider the  direction  in  which  to  exert  the  proper  pressure  for  secur- 
ing the  jaw.  It  usually  happens  in  cases  of  fracture  that  the 
muscles  in  contracting  tend  not  only  to  depress  the  jaw,  but  to 
draw  it  backward,  especially  if  the  fracture  be  in  the  region  of  the 
last  molar.  Consequently  such  teeth  for  anchorage  should  be 
selected  as  shall  use  pressure  not  only  upward  but  forward,  as  in 
Fig.  105. 

This  is  only  a  general  rule,  however,  but  I  would  specially  advise 
that  the  direction  of  force  necessary  in  each  case  should  be  care- 
fully considered,  and  then  the  bands  and  buttons  be  adjusted  ac- 
cordingly. 

Sometimes  it  is  an  advantage  to  band  more  than  one  tooth  in 
order  to  distribute  the  power  exactly  in  the  direction  necessary. 
Should  any  of  the  teeth  which  have  been  selected  for  anchorage 
show  a  tendency  to  elongation,  the  bands  should  be  shifted  to 


FINAL    SUGGESTIONS    ON    FRACTURES.  99 

Other  teeth,  or  the  direction  of  the  force  be  changed.  In  but 
two  instances  have  I  noted  this  comphcation,  and  I  am  inchned 
to  beheve  that  one  of  the  cases  was  due  to  the  band  shpping  and 
impinging  upon  the  gum,  and  thus  probably  producing  the  same 
result  as  when  a  hgature  is  carelessly  left  about  the  tooth. 

Should  it  be  found  advisable  to  employ  the  plan  illustrated  by 
Fig.  112  or  Fig.  113  in  the  treatment  of  a  case,  it  will  sometimes 
be  found  an  advantage  to  support  the  jaw  by  the  first  plan  (Fig. 
99),  for  a  few  days,  or  until  the  wounds  are  in  more  favorable  con- 
dition for  taking  an  impression  or  adjusting  the  apparatus. 

After  the  jaw  has  been  properly  set,  the  muscles  relax  in  a  few 
hours  so  that  the  strain  upon  the  ligature  and  anchor-tooth  is 
slight. 

\'ery  often  patients  receive  severe  bruises  and  internal  injuries 
at  the  time  the  fracture  is  sustained,  and  these  may  occasion  vomit- 
ing, more  or  less  violent.  Therefore  especial  caution  should  be 
observed  that  the  securing  of  the  jaw  be  delayed  until  all  tendency 
to  nausea  has  subsided.  Be  in  no  haste,  for  I  know  of  no  ill  ef- 
fects from  a  few  hours'  or  even  days'  delay  in  setting  a  fracture. 
Should  it  be  advisable  to  immediately  set  the  fracture,  it  might  be 
well  to  provide  the  attendant  with  a  pair  of  strong  scissors  to  cut 
the  ligatures  if  symptoms  of  nausea  develop. 

It  should  require  but  little  argument  to  mipress  the  importance 
of  extreme  cleanliness  about  the  mouth  during  the  treatment  of 
fractures.  Frequent  rinsing  of  the  mouth  with  proper  antiseptic 
solutions  should  be  insisted  upon.  If  the  fracture  is  more  or  less 
comminuted,  as  is  frequently  the  case,  suppuration  may  be  ex- 
pected. The  plan,  then,  which  has  been  most  successful  with  me, 
is  extra  cleanliness  of  the  wound  by  fre(|uent  injections  of  pure, 
fresh  peroxid  of  hydrogen  with  a  suitable  syringe.  The  patient  or 
the  attendant,  with  a  little  experience,  can  accomplish  this  quite  as 
well  as  the  surgeon.  Patience  and  persistence  in  this  line  will 
soon  cause  the  necrotic  fragments  to  be  washed  out.  Only  in  one 
instance,  in  my  experience,  has  it  seemed  necessary  to  interfere 
with  the  wound  by  scraping  the  bone  with  instruments. 

While  the  patient  is  undergoing  treatment,  his  general  health 
should  also  not  be  allowed  to  become  impaired.  Plenty  of  exer- 
cise in  the  open  air,  if  other  injuries  do  not  prevent,  should  be 
insisted  upon,  as  well  as  a  re(|uisitc  amount  of  nourishing  food, 
and  the  surgeon  should  occasionally  inspect  the  bands  and  liga- 
tures, to  sec  that  they  are  in  order,  so  that  the  jaw  shall  not  be 
allowed  to  get  loose,  aflmitting  movement  between  the  fractured 
ends  of  the  hones.     Should  one  of  the  bf)nes  become  broken,  it 


lOO  THE   ANGLE   SYSTEM. 

should  be  replaced  as  quickly  as  possible.  No  special  harm  will 
come  from  cutting  the  ligatures  and  separating  the  jaws,  for  the 
purpose  of  replacing  it. 

In  cases  where  a  section  of  the  bone  shows  a  tendency  to  lean, 
so  that  the  teeth  do  not  properly  occlude,  a  finger  of  metal  made  to 
bear  against  a  tooth  in  the  leaning  section  and  soldered  to  a  band 
encircling  some  favorably  located  anchor-tooth,  will  effectually 
restore  the  proper  occlusion. 

In  like  manner  the  range  of  application  of  this  method  of  retain- 
ing fractures  may  be  extended  to  cases  where  fractures  occur  in 
the  body  of  the  bone  and  the  molars  are  absent.  The  edentulous 
portion  of  the  jaw  may  be  securely  held  in  proper  position  by  a 
prop  made  to  bear  against  the  section  of  bone,  and  kept  in  place  by 
attachment  to  a  band  secured  about  one  of  the  molars  or  bicuspids 
in  the  upper  jaw. 

The  methods  so  far  offered  will,  I  believe,  nearly  cover  the  entire 
range  of  cases  requiring  treatment.  There  still  remains,  however, 
one  distinct  class  for  consideration,  namely:  the  edentulous  patient. 
Fortunately,  patients  of  this  class  requiring  treatment  are  exceed- 
ingly rare,  and  probably  the  best  plan  is  the  Gunning  splint,  or 
what  is  the  same  in  principle,  attaching  together  by  wire  or  vulcan- 
ite the  artificial  dentures,  should  the  patient  possess  them. 

The  cases  of  fractures  so  far  described  have  been  confined  to 
the  inferior  maxilla.  The  methods,  however,  of  securing  fixation 
are  all  more  or  less  applicable  to  the  treatment  of  fractures  in  the 
upper  jaw  as  well,  though  I  believe  the  one  first  described  is  most 
applicable;  for  the  reason  that,  if  one  of  the  superior  maxillary 
bones  is  fractured,  it  will  be  more  or  less  displaced  and  usually 
forced  downward.  After  carefully  replacing  the  pieces,  the  jaws 
are  closed  and  the  teeth  articulated,  and  the  pieces  thus  supported 
and  held  upward  in  position  by  the  lower  jaw  secured  in  the  usual 
way  by  bands,  buttons,  and  ligatures,  attached  on  the  uninjured 
side. 

Finally,  as  all  the  apparatus  possessing  any  special  merit  in 
the  treatment  of  fractures  of  the  maxillae  have  been  invented  by 
dentists,  and  their  familiarity  with  the  parts,  special  knowledge  of 
mechanics,  and  facilities  at  their  command  fit  them  above  all  other 
surgeons  for  tHis  work,  I  would  recommend  that  the  different  den- 
tal societies  throughout  the  country  shall  secure  appointments  of 
competent  dentists,  in  all  hospitals,  for  the  treatment  of  these 
lesions,  for  to  them  this  special  line  of  surgery  justly  belongs. 


DR.  EDWARD  H.  ANGLE  S  REGULATING  IMPLEMENTS. 

SET  No.  1. 

Patented  March  5,  1SS9. 


lOI 


PRICES. 
Set  No.  I,  complete  (including  100  page  descriptive  Book). 


.$500 


PARTS  separ.^te: 

Traction  Screw  "A"  and  "D" $125 

"      "B"  and  "C" 100 

Jack-Screw  "E"  and  "J" ^-^^ 

Coils  of  Band  Material  "F"  and  "H" each     .50 

Retaining  Wire  "G" 50 

Rotating  Levers  "L" per  J^  doz.     .25 

Retaining  Pipes  "R" set  of  ten     .75 

Wrench  each     .15 

EXTRA  PARTS. 

Adjustable  Clamp  Bands  for  Bicuspids  and  Molars. 
Fig.   I.  Fig.  2.  Fig.  3.  Fig.  4. 


Q. 

Bicuspid. 


Molar. 


Bicuspid. 


Molar. 


PRICES. 

Adjustable  Bands  Nos.  i  and  2 each  $1.00 

"        Fracture  Bands  Nos.  3  and  4 1  '" 

THE  S.  S.  WHITE  DENTAL  MFG.  00.,  Sole  Agent. 


I02  DR.   EDWARD  H.  ANGLE  S  REGULATING  IMPLEMENTS. 

SET  No.  2. 

Patented  Nov.  6,  1SS9. 


PRICES. 

Set  No.  2,  complete  (including  100  page  descriptive  Book) $6.50 

PARTS  separ.\te: 

,    Traction   Bar   "A" each  $2.00 

■—Wire  Arch  "B" "       1.50 

X'Two  Anchor  Bands  and  Pipes  "D,"  complete "       1.50 

Coils  of  Band  Material "         .50 

•—Heavy  Elastic  Bands set  of  six      .10 

Wrench   each      .15 

EXTRA  PARTS. 

Head  Gear. 

Patented. 


PRICE. 

Head  Gear,  with  Heavy  Elastic  Bands each  $4.00 

The  cut  shows  the  Traction  Bar  "A,"  not  included  in  price. 

THE  S.  S.  WHITE  DENTAL  MFG.  00.,  Sole  Agent. 


DR.   EDWARD  H.  ANGLE  S  REGULATING  IMPLEMENTS.  IO3 

EXTRA  PARTS. 

Chin  Retractor. 


PRICE. 
Chin  Retractor  (without  Head  Gear).... 


.each  $2.50 


EXPANSION  ARCH. 


THE  8.  S.  WHITE  DENTAL  MFG.  00.,  Sole  Agent. 


ANNEALED  WIRE. 

For  Ligatures  in  Regulating. 

Dr.  Angle  remarks  that  spring  wire  will  not  do.  Wc  ofTer  Annealed 
Wire,  in  Copper  and  Brass,  and  of  the  gauges  he  prescribes  (Nos.  26  and 
28,  B.  &  S.;. 

Put  up  in  fiuarter-lb.  Spoob 

I'K  I  (.:]•;. 

Per    Spool $0.20 


104  DR.  EDWARD  H.  ANGLE  S  REGULATING  IMPLEMENTS. 


(See  Fig.  8  B,  and  pages  20  and  49.) 

Regulating  Pliers. 

Patented  March  ig,  1895. 


(See  Fig.  8  B,  and 
page  15.) 

Band  Driver. 


Price,  20  cents. 


(See  Fig.  8  A,  and 
page  20.) 

Annealing  Pliers. 


No.  12. 

'rice,  $1.00 


Price,  $3.75. 

THE  S.  S.  WHITE  DENTAL  MPG.  00. 


DR.  ED\^"ARD  H.  AN'GLE  S  REGULATING  IMPLEMENTS, 


10  = 


BAND-FORMING  PLIERS. 

Patented  September  13,  1898. 
Designed  by  Dr.  Edward  H.  Angle. 

The  Band-Forming  Pliers  are  made 
especially  for  pinching  or  forming  the 
plain  bands  about  the  crowns  of  teeth  in 
regulating,  and  about  roots  in  crowning. 

The  angle  of  the  beaks  and  plurality 
of  operating  edges  make  them  equally 
adapted  to  forming  the  seam  upon  the 
lingual  or  labial  surfaces  of  the  teeth  in 
either  jaw  without  requiring  a  cramped 
position  of  the  hand. 

Between    the    beaks    are    square    and 
round  grooves  for  holding  wire,  nuts,  etc. 
Price $2.25 


Band  Soldering 
Pliers. 

Designed  by 
Dr.  Edward  H.  Ancle. 


These  Pliers  are  for  holding 
bands  when  soldering. 

The  pressure  is  brought  to 
bear  evenly  and  at  the  exact 
point  required,  and  away  from 
contact  with  the  solder  while 
in  the  flame.    The  angle  of  the 

beaks  permits  the  least  absorption   of  luat,  and   wilhout  injury 
or  change  of  form. 

Price $0.70 


Io6  THE  S.   S.  WHITE  DENTAL  MFG.  CO. 

(See  Fig.  8  A,  and  page  20.)  (See  Fig.  8  A,  and  page  80.) 

Solid  Steel  Cutting  Nippers.     Spring  Wire  Ooiler  and  Bender. 


Price each  $1.75 

(See  Fig.  8  B,  and  page  21.) 

Herapath  Blow-Pipe. 


Price,  Plain per  pair  $0.80 

"       Nickel-plated "  i.oo 


Ph 


(See  Fig.  8  B,  and  page  20.) 

Melotte's  Combination  Anvil  and  Bench-Block. 

Patented  September  13,  1892. 


Price each  $3.00 


THE  S.   S.  WHITE  DENTAL  MFG.   CO. 


107 


How's  Crown  Pliers. 

(See  Fig.  8  A,  and  pages  17  and  20.) 


Laboratory 
and  Office  Pliers. 


No.  10.  Wo.  11. 

Xos.  10  and  11,  straiglit  and  cnrved 
Pliers  for  bending  pin.s  over  posts  in 
Dr.  How's  process  of  mounting  arti- 
ficial tooth-crowns. 

PRICES. 
No.    10,    Nickcl-i)Iated,   Straight  $1.5^' 
No.    II,    Nickel-plated,    Curved      1.75 


A  jjair  of  neat,  well-made 
long-nose  Pliers,  which  find 
many  uses  in  office  and  labora- 
tory. Steel  throughout;  nick- 
eled all  over. 

Price per  i)air  $1.50 


io8 


THE  S.   S.  WHITE  DENTAL  MFG.  CO. 

(See  Fig.  8  A,  and  page  17.) 

Plate  Shears  for  Crown-  and  Bridg-e-Work. 


Lignum  Vitse  or  Iron-Wood 
Head. 

Rosewood  Handle. 

Length,  10J/2  inches. 

Price each  $0.30 


Solder 
Tweezers  "A." 


Prices,  Straight,  .per  pair  $0.60 


Curved. 


.85 


Price,  $0.25 


THE  S.  S.  WHITE  DENTAL  MFG.  CO. 

ANGLE'S  IMPRESSION  TRAYS. 

See  page  24  for  description. 
UPPER,  Nos.  21,  22,  and  23. 


109 


Price each  $0.35 


no  THE  S.   S.  WHITE  DENTAL  MFG.   CO. 

ANGLE'S  IMPRESSION  TRAYS. 


See  page  24  for  description. 


Price each    $0.35 


THE  S.  S.  WHITE  DENTAL  MFG.  CO. 


Ill 


ANGLE'S  IMPRESSION  TRAYS. 

See  page  24  for  description. 
LOWER,  Nos.  24,  25,  and  26. 


Price t-"ach  $0.35 


112  THE  S.  S.  WHITE  DENTAL  MFG.   CO. 

ANGLE'S  IMPRESSION  TRAYS. 


See  page  24  for  description. 


Price ^ach  $0.35 


COLUMBIA  UNIVERSITY  LIBRARY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 


DATE  BORROWED 


DATE  DUE 


DATE  BORROWED 


DATE  DUE 


^.P'^4   iQ.ta 


K 


KK521 


An4 
1897 


The  iingle    sjrstein  of   reii;ulation  and 
retention  of  the  teeth 


V 


-'    OL. 


194o 


C 


/2.(^    ON  PEIISONAL  RESERVE  SHELF^2.//t 


^^ 


7^(\ 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi.stx) 

RK  521  An4  1897  C.I 

The  Annie  '.v.T--'  'H  ^ca'ii.itin!!  :vv\  reten 


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